Hernia Nucleus Pulposus (HNP)

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What is Hernia Nucleus Pulposus (HNP)?

Hernia is a medical condition that occurs when an internal organ protrudes through an opening in the tissue. The nucleus pulposus is a semi-fluid mass made of white elastic fibers that form the center of the intervertebral disc called the spinal disc. In Hernia Nucleus Pulposus (HNP), this spinal pad/disc comes out and clamps the nerves in the spine, causing extreme pain that spreads to the pelvis, neck and back depending on where the pinched nerve is. People know of HNP as a “pinched nerve”.

Hernia Nucleus Pulposus (HNP) is divided into 4 grades based on the hernia condition, namely:

  • HNP Grade 1 Intervertebral disc protrusion: the nucleus looks ‘bulging’ in one direction without damage to the annulus fibrosus.
  • HNP Grade 2 Intervertebral disc prolapse: the nucleus moves, but is still in the loop of the annulus fibrosus.
  • HNP Grade 3 Intervertebral disc extrusion: the nucleus exits and the annulus fibrosus lies under the ligament, the posterior longitudinal.
  • HNP Grade 4 Intervertebral disc sequestration: the nucleus penetrates the posterior longitudinal ligament.

Causes of Hernia Nucleus Pulposus (HNP)

The prevalence of HNP is 1-2% of the population and mostly affects people from the age of 30-50. HNP can improve after treatment and can be prevented by avoiding its risk factors:

  • Age. This is the main factor for someone to develop HNP. As you get older, the elasticity of the annulus fibrosus decreases and stiffens, which makes it easily deformed and damaged.
  • Trauma. HNP can occur in patients who have experienced trauma (from falling) that causes pressure on the vertebral column (spine).
  • Profession. Patients whose work involves lifting heavy objects are at risk for HNP. HNP can also be triggered by a job that requires sitting for long periods of time
  • Gender. Men are at twice the risk of getting HNP compared to women. This is because men are more often exposed to strenuous activities as compared to women.

Consultation with an Orthopaedist


To diagnose HNP, doctors need to conduct detailed interviews related to the patient’s symptoms, the patient’s medical history and the patient’s occupation and activities. The doctor will also perform a physical test to examine body posture, reflexes and muscle strength. The doctor will then assess the patient’s ability to walk and the severity of pain experienced by the patient.

The following additional tests are required to provide a more accurate diagnosis of HNP. They are: 

  • X-ray. X-Ray images can describe the condition of the spine in cases of HNP. The doctor will get a clearer look of the narrowed gap or altered alignment of the spine affected by HNP. 
  • MRI. MRI (Magnetic Resonance Imaging) is the main standard test in diagnosing HNP. MRI utilises magnetic fields and radio wave energy to display images of structures and organs in the body. With this method, the spinal structure and the presence of herniation (HNP) will be clearly visible.
  • Electromyography. Electromyography can help see the conduction of the nerve. This test is performed to identify damage to the pinched nerve.

Symptoms of Hernia Nucleus Pulposus (HNP)

The most common symptom of HNP is neck and back pain. You will feel more pain when sitting, sneezing and walking. In general, the symptoms of HNP can improve within 3 months, but might also turn into a chronic condition. Common symptoms experienced by HNP sufferers include: 

  • Numbness
  • Tingling sensation 
  • Moderate to severe pain
  • Weakness in several body parts
  • Inability to control the frequency of urination and bowel movements

Treatment for Hernia Nucleus Pulposus (HNP)

Treatment for Nucleus Pulposus Hernia (HNP) can be done through physical therapy, pharmacology and surgery. Physical therapy includes warm / cold compresses, Iontophoresis (using steroids on the skin to reduce inflammation), TENS units (Transcutaneous Electrical Nerve Stimulators – sending electrical impulses to the brain in order to reduce low back pain), Ultrasound (ultrasound is particularly useful in relieving acute pain and can promote tissue healing), and lifestyle changes by losing weight and strengthening muscles affected by HNP.

Pharmacological therapy includes providing analgesic drugs, anti-inflammatory drugs, and muscle relaxant.

An orthopedic specialist doctor (orthopedist) will recommend surgical therapy for HNP patients with Grade 3 and 4 severity. The surgical procedures to treat HNP may include:

  • Discectomy. A discectomy is a procedure to remove a portion of the intervertebral disc.
  • Percutaneous discectomy. Percutaneous discectomy is a procedure for removing a portion of the intervertebral disc using a needle through joint aspiration.
  • Laminectomy (laminotomy / foraminotomy / facetectomy). Laminectomy is a surgical procedure to perform neuronal decompression by removing parts of the vertebrae either partially or completely.
  • Spinal Fusion. Spinal fusion and sacroiliac joint fusion is a surgical procedure using a graph on the vertebrae to create a connective tissue between the vertebrae to maintain stability.

Treatment Cost for Hernia Nucleus Pulposus (HNP)

The treatment costs for bone-related conditions such as HNP is often determined after the doctor understands the patient’s condition. Smarter Health can help you find specialist doctors and hospitals within your treatment budget.

Prevention of Hernia Nucleus Pulposus (HNP)

  • Diet. Dietitians recommend weight loss for HNP patients so that the spine does not support too much weight. 
  • Sports. Regular sports can help train muscle weakness and reduce excess fat in the body. Doctors recommend exercising at least 30 minutes a day or 3-5 times a week. Swimming and running are ideal exercises. 
  • Activity. Patients with HNP should start avoiding strenuous and traumatic activities. Avoid lifting heavy objects and pay attention to proper ergonomic posture. It is also important to use a flat, hard base to maintain bone alignment.

Home Care for Patients Diagnosed with Hernia Nucleus Pulposus (HNP)

Caring for a family member with Hernia Nucleus Pulposus (HNP) may not be an easy task. You must be able to regulate a healthy lifestyle such as maintaining a healthy diet, exercising regularly while reducing strenuous activity, and reminding the patient to take medication regularly.

Start implementing a healthy lifestyle by consuming healthy food sources. You will maintain your ideal weight if you maintain a balanced diet. Additionally, your spine will also not be overloaded if you are of a healthy weight – which helps prevent recurring HNP symptoms.

Swimming and running are sports activities recommended for patients with HNP as these two sports can strengthen the muscles. Avoid strenuous exercises and sports that may cause trauma.

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