HNP Case Scenario For Case Study

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CASE STUDY SCENARIO: HERNIATED NUCLEUS PULPOSUS

A 43 year old male is seen with severe low back pain extending down the leg to the left
lateral calf region. Onset of pain was sudden and insidious of one day’s duration. He is a
construction worker for 20 years, injured his back 8 years ago while pouring a concrete. For
the last 2-4 months, prior to admission, he had low back stiffness with progressive tension
up the spine and increasing severe pain mostly in the left hip region radiating down to the
back of his thigh to the left lateral calf. Upon admission in the Emergency Room, he claim
that he is unable to get out of bed without assistance of his wife and requires help to shower
and dress, waking in the night every 2-3 hours with severe buttock and posterior thigh pain
and denies any pins, needles or numbness but his right leg has become heavy.

The patient is living in Lucban, Quezon, a quiet and peaceful place, living together
with her husband who is a X-ray Technician. The couple is well-known in their community
and active to any programs in their barangay,church and other social activities. As a
construction worker, he need to wake up at 4:00 am and her work usually starts at 7 am and
ends at 5 pm, requires him to travel daily from their home. Early in the morning, he used to
water his plants in their small garden and spent his off days by gardening. He drinks alcohol
occasionally and can consume 3-5 sticks of cigarette/day. His parents died of stroke. He
had 2 children, married already and 3 brothers, also a construction workers, all married, with
no known disease.

Initially, an Ibuprofen and Panadeine forte 1 tab every 6 hours had been prescribed
while in the Emergency Room. The following day, a lumbar spine CT ordered and reported a
L5S1 disc protrusion with right S1 nerve root compression. Also an MRI was ordered for
confirmation. Sagittal and axial MRI sections revealed a large right-sided L5-S1 extruded
with superior migration up to the level of the L5 vertebral body. This herniated disc was
resulting in severe L5 -S1 spinal stenosis and compression the right-sided of nerve roots
(radiculopathy) manifesting in pain, numbness and weakness. All his routine laboratory
works were normal.

The client completed a 4-week conservative treatment plan that consisted of spinal
stabilization, pain relief modalities, and soft tissue mobilization. He responded positively to
methods such as electrical muscle stimulation, acupuncture, and myofascial release therapy.
A pelvic girdle traction was also applied. These treatments aided in the process of reversing
the inflammation as a result of the herniated disc. Although, he responded positively to the
treatment, the patient continued to experience pain especially when sitting for longer than
one hour. He was prescribed pain medication such as NSAIDs, which were not helpful in
relieving his pain.

The patient was referred to an orthopedic surgeon and ordered micro-discectomy


under general anesthesia. The client undergone a microdiscectomy and went home 1 day
after the procedure. Weakness and numbness resolved after few days. Subsequently, his
symptoms significantly decreased and he was able to return to normal ADL’s without
experiencing pain. The patient was cleared to return to his usual activities and further follow
up was suggested but discouraged to return from his previous job as laborer.

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