{
  "$schema": "https://ui.shadcn.com/schema/registry-item.json",
  "name": "lumbar-disc-herniation",
  "title": "Lumbar disc herniation",
  "description": "A posterolateral L5–S1 disc herniation on the spine, compressing the S1 root of the cauda equina, from sciatica to recovery as the herniation regresses, or a massive central herniation causing cauda equina syndrome, with the neurological signs at each stage. Model licensed CC BY-SA 2.1 JP.",
  "registryDependencies": [
    "@organui/disease-viewer",
    "@organui/spinal-cord"
  ],
  "files": [
    {
      "path": "registry/base-nova/lumbar-disc-herniation/lumbar-disc-herniation.tsx",
      "content": "import { diseaseModel, type Disease } from \"@/components/disease-model\"\nimport {\n  DiseaseViewer,\n  type DiseaseViewerProps,\n} from \"@/components/disease-viewer\"\nimport { spinalCordModel } from \"@/components/spinal-cord\"\n\n// A posterolateral L5–S1 disc herniation pressing on the S1 nerve root: the\n// commonest cause of sciatica, which mostly settles on its own, and rarely a\n// central herniation that compresses the whole cauda equina.\nexport const lumbarDiscHerniation: Disease = {\n  name: \"Lumbar disc herniation\",\n  code: \"M51.1\",\n  summary:\n    \"The soft centre of a lumbar disc bulges through a tear in its outer ring and presses on a nerve root, causing sciatica: pain down the leg, worse than the back pain. Most settle within three months without surgery.\",\n  scales: [\n    {\n      id: \"spinal-cord\",\n      label: \"Spine\",\n      model: spinalCordModel,\n      findings: {\n        \"disc-l5-s1\": {\n          affected: true,\n          description:\n            \"The nucleus pulposus has pushed through a tear in the annulus fibrosus, behind and to one side, where the posterior longitudinal ligament is thinnest. It sits in the path of the S1 root.\",\n        },\n        \"cauda-equina\": {\n          affected: true,\n          label: \"S1 nerve root\",\n          description:\n            \"The S1 root is compressed and inflamed: pain down the back of the leg into the sole and outer foot, numbness there, weak pushing off with the foot and a reduced ankle reflex. Raising the straight leg stretches the root and brings on the pain.\",\n        },\n        \"disc-l4-l5\": {\n          affected: false,\n          description:\n            \"Normal here. The other common level: a herniation here presses on the L5 root, with weak lifting of the big toe and numbness on the top of the foot.\",\n        },\n        \"spinal-cord\": {\n          affected: false,\n          description:\n            \"Ends at about L1–L2, above the lumbar discs, so a lumbar herniation presses on nerve roots, not the cord.\",\n        },\n        \"vertebra-l5\": {\n          affected: false,\n          description:\n            \"Normal. Back pain with weight loss, fever or past cancer raises concern for infection or cancer in the spine.\",\n        },\n        sacrum: {\n          affected: false,\n          description: \"Normal.\",\n        },\n      },\n    },\n  ],\n  stages: [\n    {\n      id: \"sciatica\",\n      label: \"Sciatica\",\n      time: \"Weeks 0–6\",\n      summary:\n        \"Leg pain worse than back pain, often after lifting or bending, with numbness and weakness in one root's territory. Without red flags, no scan is needed yet.\",\n    },\n    {\n      id: \"recovered\",\n      label: \"Recovered\",\n      time: \"By 3 months, in most\",\n      summary:\n        \"The herniated part shrinks as the body reabsorbs it, and the root recovers. Most need no surgery.\",\n      findings: {\n        \"spinal-cord\": {\n          \"disc-l5-s1\": {\n            affected: true,\n            description:\n              \"The herniation has shrunk or gone; large extrusions often regress most. The disc stays slightly lower, and the back can ache from time to time.\",\n          },\n          \"cauda-equina\": {\n            affected: false,\n            label: \"S1 nerve root\",\n            description:\n              \"No longer compressed. The pain goes first; numbness and the ankle reflex can take months to recover, or stay.\",\n          },\n        },\n      },\n      investigations: [\n        { name: \"Straight leg raise\", result: \"Negative\" },\n        { name: \"Ankle reflex\", result: \"Reduced\", flag: \"low\" },\n        { name: \"Power\", result: \"Normal\" },\n      ],\n    },\n    {\n      id: \"cauda-equina-syndrome\",\n      label: \"Cauda equina syndrome\",\n      alternative: true,\n      time: \"Hours to days\",\n      summary:\n        \"A large central herniation compresses the roots below it, including those to the bladder and bowel: an emergency. Without decompression the bladder, bowel and sexual function can be lost for good.\",\n      findings: {\n        \"spinal-cord\": {\n          \"disc-l5-s1\": {\n            affected: true,\n            description:\n              \"A massive central herniation fills the spinal canal behind the disc.\",\n          },\n          \"cauda-equina\": {\n            affected: true,\n            description:\n              \"Every root below the herniation is squeezed: sciatica in both legs, numbness of the buttocks, perineum and genitals (saddle anaesthesia), loss of bladder sensation or retention, and loss of bowel control.\",\n          },\n        },\n      },\n      investigations: [\n        { name: \"Saddle sensation\", result: \"Reduced\", flag: \"abnormal\" },\n        { name: \"Bladder scan\", result: \"650 mL after voiding\", flag: \"high\" },\n        { name: \"Anal tone\", result: \"Reduced\", flag: \"low\" },\n        {\n          name: \"MRI\",\n          result: \"Central disc compressing roots\",\n          flag: \"abnormal\",\n        },\n      ],\n    },\n  ],\n  events: [\n    {\n      stage: \"sciatica\",\n      label: \"Red flags\",\n      description:\n        \"Saddle numbness, bladder, bowel or sexual change, sciatica in both legs or weakness that is getting worse need an emergency MRI, within hours, day or night.\",\n    },\n    {\n      stage: \"sciatica\",\n      label: \"Keep active\",\n      description:\n        \"Advice to stay active, and an NSAID if needed. Gabapentinoids, other antiepileptics, oral steroids and benzodiazepines are not used: they do not help and can harm. An epidural steroid injection can help severe pain.\",\n    },\n    {\n      stage: \"sciatica\",\n      label: \"MRI\",\n      time: \"After 6 weeks\",\n      description:\n        \"For pain still disabling after six weeks or so, when surgery is being considered; the herniation must match the symptoms.\",\n    },\n    {\n      stage: \"sciatica\",\n      label: \"Discectomy\",\n      time: \"If still disabling\",\n      description:\n        \"Removing the herniated part relieves leg pain faster than waiting, though results are similar after a year.\",\n    },\n    {\n      stage: \"cauda-equina-syndrome\",\n      label: \"Decompression\",\n      time: \"Emergency\",\n      description:\n        \"An MRI as soon as it is suspected, then surgery to remove the disc and free the roots without delay.\",\n    },\n  ],\n  investigations: [\n    { name: \"Straight leg raise\", result: \"Positive at 40°\", flag: \"abnormal\" },\n    { name: \"Ankle reflex\", result: \"Reduced\", flag: \"low\" },\n    { name: \"Plantarflexion\", result: \"Mildly weak\", flag: \"low\" },\n    { name: \"Red flags\", result: \"None\" },\n  ],\n}\n\n/** The spine with sciatica, the stage the viewer opens on. */\nexport const lumbarDiscHerniationModel = diseaseModel(lumbarDiscHerniation)\n\nexport type LumbarDiscHerniationProps = Omit<DiseaseViewerProps, \"disease\">\n\nexport function LumbarDiscHerniation(props: LumbarDiscHerniationProps) {\n  return <DiseaseViewer disease={lumbarDiscHerniation} {...props} />\n}\n",
      "type": "registry:component"
    }
  ],
  "docs": "Lumbar disc herniation docs: https://organui.com/docs/components/lumbar-disc-herniation. It reuses the spinal cord model, licensed CC BY-SA 2.1 JP (https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en); keep the viewer's credit visible. Educational, not for diagnosis.",
  "categories": [
    "disease",
    "nervous"
  ],
  "type": "registry:component"
}