Pathophysiology of Herniated Nucleus Pulposus (HNP)
Herniated nucleus pulposus (HNP) can be caused by degenerative processes and trauma caused by (falls, accidents, and repeated minor stress such as lifting heavy objects) that lasts for a long time. Intervertebral discs is the tissue that lies between the two vertebrae, which is surrounded by the annulus fibrosus which consists of concentric tissue and fibrocartilage, which there are semi-liquid substance. This substance, called the nucleus pulposus containing files colagenoza fibers, connective tissue cells and cartilage cells. This material serves as shock absorbers between adjacent vertebral bodies, and also plays an important role in the exchange of fluids between the disc and the capillary. Intervertebral disc is formed around a quarter of the overall length of the vertebral column. Most thin disc located in the lumbar region. As we get older, the water content of the disc is reduced (from 90 % in infancy to 70 % in the elderly) and the disc becomes thinner so that the risk of HNP becomes larger. Polysaccharide protein loss in the discus lowering the water content of the nucleus pulposus.
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Fractional developments are spread in the annulus weakens the defense in the nucleus herniation. In addition, the fibers become more coarse and experienced hyalinization, which have contributed to a change that causes the HNP through the annulus along the spinal nerve compression. In the intervertebral disc herniation, bulging into the nucleus of the disc annulus (a fibrous ring around the disc) with a result of nerve compression. Polysaccharide protein loss in the discus lowering the water content of the nucleus pulposus. Fractional developments are spread in the annulus weakens the defense in the nucleus herniation. After trauma (falls, accidents, and repeated minor stress such as lifting a heavy load for a long time) can be injured cartilage , capsule lead to spinal cord or may rupture and allow the nucleus pulposus when pushed against the spinal cord arise from the spinal column.
Most of disc herniation (a gradual process characterized attacks nerve root compression) occurs in the lumbar region of the lumbar area IV to V (L4 to L5), or fifth lumbar (L5 to S1), this happens because the area is the most received heavy weight pedestal us on exertion. Directions common herniation nucleus pulposus material is posterolateral. Because the lumbar nerve root area tilt down when it exits through the neural foramen, herniated disc between L5 and S1 nerve more influence than L5 S1. (Price, 2005), (Brunner & Suddarth, 2001), (Rasjad, 2003).
Herniated Nucleus Pulposus (HNP) who attacked the lumbar usually causes severe back pain, urgency, settled a few hours to a few weeks, the pain can be intensified when coughing, sneezing, or bending, and usually spread from the lower back to the buttocks to the lower limbs. Violent paresthesia symptoms may occur after decreasing pain, deformity such as loss of lumbar lordosis or scoliosis, spinal mobility decreased movement (in the acute stage movement at the lumbar very limited, then comes the pain at the time of the extension of the spine), tenderness in the area of herniation and buttocks (paravertebral), the client also usually stand with slightly leaning to one side.
If this continues condition can cause complications which include radiculitis (nerve root irritation), spinal cord injury, parestese, paralysis of the lower limbs.
Most of disc herniation (a gradual process characterized attacks nerve root compression) occurs in the lumbar region of the lumbar area IV to V (L4 to L5), or fifth lumbar (L5 to S1), this happens because the area is the most received heavy weight pedestal us on exertion. Directions common herniation nucleus pulposus material is posterolateral. Because the lumbar nerve root area tilt down when it exits through the neural foramen, herniated disc between L5 and S1 nerve more influence than L5 S1. (Price, 2005), (Brunner & Suddarth, 2001), (Rasjad, 2003).
Herniated Nucleus Pulposus (HNP) who attacked the lumbar usually causes severe back pain, urgency, settled a few hours to a few weeks, the pain can be intensified when coughing, sneezing, or bending, and usually spread from the lower back to the buttocks to the lower limbs. Violent paresthesia symptoms may occur after decreasing pain, deformity such as loss of lumbar lordosis or scoliosis, spinal mobility decreased movement (in the acute stage movement at the lumbar very limited, then comes the pain at the time of the extension of the spine), tenderness in the area of herniation and buttocks (paravertebral), the client also usually stand with slightly leaning to one side.
If this continues condition can cause complications which include radiculitis (nerve root irritation), spinal cord injury, parestese, paralysis of the lower limbs.
