Question

While volunteering at an assisted living facility, you are asked to participate in the care of an 82 year-old female resident with limited mobility. When you are first introduced to Gladius Claymore, you notice she often rubs and taps at the side of her left hip, but still greets you with a welcoming smile. Gladius often spoke of experiencing shooting pain, numbness, and weakness on her lower back, the posterior side of her left buttocks, and her posterior lower limb. She first started experiencing these symptoms ever since she suffered a bad fall a few months back. “The doctor said I had a ‘slipped disc’ in my waist” she tells you “But I don’t get why it would make my thigh hurt!” You help Gladius make it to her physical therapy appointment and spend some time chatting with her clinician. When the clinician finds out you are taking a human anatomy class she begins to quiz you about some of the anatomy related to Gladius presentations and complications that might be associated with it. Gladius has a good time quizzing you too (and telling to when you’re wrong) and wishes you luck on your upcoming exam.          

Goal: Using the description above, describe the most likely diagnosis for Gladius’s presentation (should include anatomical terms), and compared it with an in-depth discussion of the normal, healthy anatomy (hint: should include tissue types found in the bone and joints in the vertebral column). Next, describe the common causes of this presentation, especially in someone of Gladius’ demographic group. Gladius’s presentation may cause impingement on components of the central and/or peripheral nervous system, describe those components using correct anatomical terminology. Describe the layers and spaces surrounding the spinal cord. Lastly, how might someone like you get involved with Gladius and brighten her day.           

Answer 1

As per Gladius Doctor, Gladius has a Slip Disc

Slip Disc is also known as Herniated Disc, Prolapsed Disc, Disc Rupture.

Where does Slip Disc occurs?

Slip disc occurs in the vertebrae.

Anatomical Structure of Vertebrae

Spinal column is made up of a series of bones called vertebrae stacked onto each other.

THE Bones are as follows from top to bottom

Cervical Spine - 7

Thoracic Spine - 12

Lumbar Spine - 5

Sacrum - 5 fused

Coccyx - 4 fused

All these bones are cushioned by discsa and the discs protect the bones by absorbing the shocks from daily activities like lifting, and twisting, running, jumping

Each disc has two parts: a soft, gelatinous inner portion and a tough outer ring.

Intervertebral discs made of the central nucleus pulposus surrounded by the annulus fibrosus; enhanced with the anterior longitudinal ligament (connects the anterolateral aspects of the vertebral bodies) and posterior longitudinal ligament (connects the posterior aspects of the vertebral bodies)

Joints of the arches - Zygapophyseal joints between the superior and inferior articular processes of adjacent vertebrae; enhanced with accessory ligaments that unite the intravertebral discs, transverse processes, and spinous processes and help stabilize the joints

Slip Disc

Any Injury or weakness can cause the inner portion of the disc to protrude through the outer ring. This is known as a slipped Disc herniated which leads to severe pain and discomfort.

If disc material herniates, or squeezes out, this pressurizes the spinal cord or spinal nerves. This causes severe pain in the path of the nerve being squeezes. Pressure against the nerve root from aherniated disc can cause numbness and weakness along the nerve.

Causes of Slip Discs

1. Injury

2. Fall

3. Activities like twisting, jumping

4. Overweight

5. Sedentary Life style

6. Muscle Weakness

7. Ageing

Symptoms of slip disc

1. Pain (Most commonly on one side of the body)
2. Numbness (Most commonly on one side of the body)
3. Pain that extends to your arms or legs
4. Worsening of pain with certain activities or movements
5. Pain that worsens after standing or sitting especially during nights
6. Muscle weakness
7. Tingling or Burning sensations in the affected area

How a Slip Disc can be diagnosed

1. X-rays
2. CT scans
3. MRI scans
4. Discograms

Slip Disc Treatment

Conservative Treatment

Exercises - Muscle Strengthening pograms

Medications - Pain relivers, Muscle Relaxers

If the Conservative treatment fails then can opt for Surgery

Surgical Treatment

Microdiskectomy

Laminectomy

Spinal Fusion

Complications of Slip Disc if not treated

Permanent Nerve Damage

Saddle Anesthesia (Slipped disc compresses nerves and causes you to lose sensation in your inner thighs, the back of your legs, and around your rectum)

In very rare cases, a slipped disc can cut off nerve impulses to the cauda equina nerves in your lower back and legs leading to lose bowel or bladder control.

Layers and spaces surrounding the Spinal Cord

The three membranes (the dura mater, arachnoid, and pia mater) that line the skull and vertebral canal and enclose the brain and spinal cord.

Dura Mater

The dura mater is the most superior of the meningeal layers. Its name means "hard mother" in Latin and it is tough and inflexible. This tissue forms several structures that separate the cranial cavity into compartments and protect the brain from displacement.

The falx cerebri separates the hemispheres of the cerebrum.

The falx cerebelli separates the lobes of the cerebellum.

The tentorium cerebelli separates the cerebrum from the cerebellum.

The dura mater also forms several vein-like sinuses that carry blood (which has already given its supply of oxygen and nutrients to the brain) back to the heart.

The superior sagittal sinus runs across the top of the brain in an anterior-posterior direction.

Other sinuses include the straight sinus, the inferior sinus, and the transverse sinus.

The epidural space is a potential space between the dura mater and the skull. If there is hemorrhaging in the brain, blood may collect here. Adults are more likely than children to bleed here as a result of closed head injury.

The subdural space is another potential space. It is between the dura mater and the middle layer of the meninges, the arachnoid mater. When bleeding occurs in the cranium, blood may collect here and push down on the lower layers of the meninges. If bleeding continues, brain damage will result from this pressure. Children are especially likely to have bleeding in the subdural space in cases of head injury.

Arachnoid Mater

The arachnoid or arachnoid mater is the middle layer of the meninges. In some areas, it projects into the sinuses formed by the dura mater. These projections are the arachnoid granulation/arachnoid villi. They transfer cerebrospinal fluid from the ventricles back into the bloodstream.

The subarachanoid space lies between the arachnoid and pia mater. It is filled with cerebrospinal fluid. All blood vessels entering the brain, as well as cranial nerves pass through this space. The term arachnoid refers to the spider web like appearance of the blood vessels within the space.

Pia Mater

The pia mater is the innermost layer of the meninges. Unlike the other layers, this tissue adheres closely to the brain, running down into the sulci and fissures of the cortex. It fuses with the ependyma, the membranous lining of the ventricles to form structures called the choroid plexes which produce cerebrospinal fluid.

Reassuring Gladius to brighten her day

Don’t ignore your symptoms and assume they’ll just get better

Take steps to remain active and get exercise.

Don’t do anything you’ve been advised to avoid, such as climbing stairs, lifting objects

Eat a balanced diet high in lean proteins and antioxidants to support tissue regeneration and speed your herniated disc recovery time. If you have dietary restrictions, discuss a dietary plan with your surgeon or dietician to ensure you’re receiving everything you need to heal optimally.

Don’t skip taking your pain medications as directed

Providing Positive Affirmations for Gladius