[UKMPPD - SKDI REVIEW] Hernia Nucleus Pulposus (HNP) - Dimengerti, bukan dihapal! | Sistem Saraf #68

Summary

In this video, the presenter discusses Hernia Nukleus Pulposus (HNP), a condition where the nucleus pulposus of the intervertebral disc shifts out of place, causing potential nerve compression. The video covers its anatomy, common age groups affected, and pathophysiology of the condition, including different stages of herniation (protrusion, extrusion, and sequestration). It also explains the impact on cervical and lumbar regions, diagnostic methods like MRI, physical examination techniques (e.g., Spurling test, Lasegue's test), and treatment approaches ranging from conservative care to surgery like hemilaminectomy. The content is designed for educational purposes, emphasizing understanding and clinical application.

Takeaways

• 😀 Hernia Nucleus Pulposus (HNP) is a common condition where the nucleus pulposus shifts from its normal position in the intervertebral disc, often affecting people aged 30-50.
• 😀 The condition can develop due to the degeneration of the annulus fibrosus, which allows the nucleus pulposus to push asymmetrically, leading to disc protrusion, extrusion, or sequestration.
• 😀 The cervical spine (neck area) and lumbar spine (lower back area) are the most commonly affected areas, with HNP in these regions potentially causing nerve compression and radiculopathy.
• 😀 For cervical HNP, symptoms may include radicular pain, sensory deficits, and muscle weakness depending on which nerve root is compressed (e.g., C5, C6, C7, or C8).
• 😀 For lumbar HNP, the symptoms might include low back pain and radicular pain radiating down the leg, with possible motor deficits in the lower extremities depending on the affected nerve root (e.g., L3, L4, L5, or S1).
• 😀 The condition can be classified based on the lateralization of the herniation and the severity of the disc bulge, which helps determine the management approach.
• 😀 Diagnostic tests like MRI or CT myelography are used to visualize the herniated disc and confirm the diagnosis.
• 😀 Conservative treatment options include physical therapy, pain management with NSAIDs, and activity limitation to reduce strain on the spine.
• 😀 Surgical intervention, such as hemilaminectomy, is considered if conservative treatments fail or if there is significant compression causing neurological deficits.
• 😀 In cases of central HNP or cauda equina syndrome, where the spinal cord or lower spinal nerves are compressed, urgent surgical intervention is needed to prevent permanent damage.

Q & A

What is Hernia Nukleus Pulposus (HNP)?

Hernia Nukleus Pulposus (HNP), or disc herniation, is a condition where the nucleus pulposus (the gel-like core of the intervertebral disc) moves out of its normal position in the intervertebral disc, causing pressure on the spinal nerves.

What is the most common age group affected by HNP?

The most common age group affected by HNP is adults in their 30s to 50s, as the nucleus pulposus remains gelatinous and prone to herniation in these years.

Why are men more likely to develop HNP than women?

Men are more likely to develop HNP than women, with the incidence being about twice as high in men. The reasons for this are still under research but may involve factors such as lifestyle, work habits, and genetics.

How does the anatomical structure of the spine relate to HNP?

The spine's structure, particularly the intervertebral discs composed of the annulus fibrosus (the outer layer) and nucleus pulposus (the inner gel-like substance), plays a crucial role in HNP. Degeneration or damage to the annulus fibrosus can allow the nucleus pulposus to bulge out, causing nerve compression.

What is the progression of a herniated disc in HNP?

In HNP, the nucleus pulposus first bulges out (protrusion) while still being contained within the annulus fibrosus. If it progresses, the disc material can extrude through the annulus (extrusion), leading to nerve irritation. In severe cases, the disc fragments may break off and enter the spinal canal (sequestration).

What is the significance of the Michigan State University (MSU) classification in HNP?

The MSU classification system categorizes HNP based on the location and the protrusion of the disc. It helps in understanding the severity and potential impact of the herniation, such as whether it is central, paramedian, or far lateral, and guides treatment decisions.

What are the common symptoms of cervical HNP?

Common symptoms of cervical HNP include radiating pain (radiculopathy) in the arm, weakness in specific muscles (like the biceps or triceps), and sensory deficits (numbness or tingling) in the affected dermatomes. This can result in difficulties with arm movement and strength.

What is the difference between cervical and lumbar HNP in terms of symptoms?

Cervical HNP typically causes symptoms in the upper limbs, such as pain, numbness, or weakness in the arm. In contrast, lumbar HNP primarily affects the lower limbs, causing lower back pain, radiating leg pain (sciatica), and potentially weakness in the leg muscles.

What are some common diagnostic tests for HNP?

Common diagnostic tests for HNP include MRI (Magnetic Resonance Imaging) to visualize the intervertebral discs and nerve compression. Other tests include CT myelography and EMG (Electromyography) to assess nerve function and damage.

What is the standard treatment for HNP, and when is surgery required?

The standard treatment for HNP begins with conservative methods, including rest, physical therapy, pain management, and anti-inflammatory medications. Surgery, such as hemilaminectomy, is considered when there are signs of severe nerve compression, persistent pain, or neurological deficits that do not improve with conservative care.