Question

Mr. G, age 79 years, has always been physically active. He walks long distances on a daily basis and works out with weights. While lifting weights one day, he experienced severe lower back pain that radiated down his left leg. The leg also felt weak. His doctor diagnosed a herniated intervertebral disk and advised immediate bed rest, with frequent application of heat, and skeletal muscle relaxant drugs.

1. Discuss the pathophysiological changes and the probable location of the changes.

2. Explain why Mr. G. was told to notify the physician immediately if he was unable to urinate.

3. Why is it important for Mr. G. to use muscle relaxant drugs and apply heat at this stage?

4. Discuss possible complications and any further treatment that might be required. 5. Explain why this herniated disk may cause recurrent problems.

Answer 1

1. Mr G experienced severe lower back pain that radiated down his left leg and also felt weak , as per given data. So according to the diagnosis of herniated intervertebral disk , the spinal nerves in the lumbar and sacral regions gets affected. The herniated intervertebral disk compress the spinal nerves. So the spinal nerves , wherever it supplies , in those areas , the function gets affected. According to given data , aging and heavy weight lifting are the probable causes for herniated intervertebral disk.Due to these causes , the intervertebral disk gets protruded in the left side. There by , it compress the left spinal nerves , which supplies the bladder and left leg.

2. When Mr G is unable to urinate , that indicates the spinal nerves which supplies the bladder gets affected. The spinal nerves present at the level of sacral 2 nd and 3 rd are the center for micturition. The injury at this level make the patient unable to urinate. Below this sacral regions , the bladder can contract but unable to empty the bladder. This condition is called neurogenic bladder. When the bladder is full , but the client unable to urinate , may lead to rupture of bladder. Rupture of bladder is an emergency situation. So whenever Mr G has unable to urinate , he should contact the physician immediately.

3. Muscle relaxant helps to relax the muscle which compress the spinal nerves. Application of heat helps to reduce muscle spasm. So the use of muscle relaxant drugs and apply heat at this stage are important for Mr G to decompress the spinal nerves or to releive pressure over the compressed spinal nerves.

4. The possible complications of herniated intervertebral disk are bladder dysfunction , weakness of leg , the compressed nerve will lost most of its function. The patient feels numbness , tingling sensation , difficult in walking , difficulty in positioning , urinary dysfunction may lead to rupture of bladder. All the sensory and motor functions of the spinal nerve gets affected.

5. The herniated disk which compress the nerve has to be decompressed. The herniated disk is affecting the nerve functions which is important for daily activities. The problems are recurrent. So inorder to decompress the spinal nerves , the herniation should be get corrected. Diskectomy is a type of surgery which helps to remove herniated disk and its related tissues. Disk surgery can be performed when the conservative treatment failed to releive the symptoms of patient.