Intervertebral Disk Disease

• Etiology/Risk Factors
  • ↑ Age
  • Trauma
• Pathophysiology
  • Anatomic changes and a loss of function of varying degrees of one or more intervertebral discs of the spine (Figure 6.40)
  • Symptoms occur when nucleus pulposus herniates and compresses a nerve root
  • Cervical disk herniates typically at C₅–C₆ or C₆–C₇
  • Lumbar disk herniates typically at L₄–L₅ or L₅–S₁
• Treatment
  • Steroids
  • Opioids
  • Physical therapy
  • Surgical intervention
• Primary Concerns
  • Difficult positioning
  • Tolerance to opioids
  • Coughing or straining will exacerbate pain at any level
  • Adrenal axis suppression
• Evaluation
  • Imaging
  • Location and quality of pain, numbness, or weakness
  • Pain medication regimen
  • Baseline neuro exam
• Anesthesia Management
  • Consider video laryngoscope or fiberoptic intubation to reduce vertebral column manipulation in the setting of cervical disease
    • Stabilize affected portion to ensure comfort
  • Stress dose steroids may be required for high‐risk patients
    • True adrenal insufficiency
    • Extensive surgical procedure
    Only gold members can continue reading. Log In or Register to continue