Disc Prolapse and Treatment
About the Disc
The Disc is constituted by an inner gel like cushioning material surrounded by tough covering. When healthy, the disc resists pressure and bounces back like a spring to any impact. With age, injury or wear and tear, the inner material loses its water content and becomes stiff. The outer covering which was once tough and firm becomes soft and may develop small tears. The inner gel like material may come out through these small tears and press on the nerves which are very close by in the spinal canal. This is called Disc Herniation or 'Slip Disc'.
Risk factors that cause Disc Herniation
- More common in males between 30 - 50 years of age
- Improper lifting / bending resulting in excess stress on the spine and low back
- Excess body weight - the spine and the disk are unable to bear the load
- Repetitive activities - this is especially common among software professionals, manual labourers etc., who repeat the unhealthy spine habits as part of their work many times a day, thus tiring the spine
- Frequent driving
- Sedentary lifestyle
Symptoms of Disc Herniation
Symptoms may be one or all of the following:
- Back pain
- Leg and/or foot pain (sciatica)
- Numbness / Weakness in the leg and/or foot
- Loss of bladder or bowel control (extremely rare) caused by pressure on the spinal nerves by the disc. It requires immediate medical attention.
Common Tests for Disc Herniation
While most cases are detected on clinical examination, your surgeon may order X-rays to make sure there is no wear and tear / incidental disease in the vertebra. The assessment of compression on the nerve by the disc is clinical and also by correlation with a MRI scan. This may be needed in many patients if they don't respond to the standard treatment of medicines, physiotherapy and rest. An MRI gives the doctor a representation of the pressure on the nerve from the bulging disc.
FAQs - Disc Prolapse
About 90 % of people experience back pain at some point in their life and most of these are disc related pains. A large percentage of these subside with non-surgical methods of treatment like pain medicines, rest, back care, physiotherapy and exercise.
Disc herniation takes place very near the spinal nerves as the inner gel-like material comes out of the spine and into the legs. When the disc presses on the nerves that are irritated and inflamed, it causes back and leg pain. Depending on the pressure, the nerve may experience pain or some nerve deficits along the lower limb. If the nerve pressure causes weakness of the muscles of lower limb, numbness, severe unrelenting pain or difficulty with passing urine / stools then urgent operative intervention will be of benefit.
The ideal of operative treatment is to remove the pressure on the nerve by the disc. This is achieved by a small cut in the back. The spine is entered disturbing as little of the muscle as possible to preserve function and the nerve is decompressed. Only the part of disc that is pressing on the nerve is removed.
Medicines, physiotherapy, exercise and back care are successful in most cases. In selected cases where they have not been beneficial, a steroid injection into the spinal canal / near the nerve is of benefit and will allow excellent recovery. The effect may last for a variable number of months. Though majority of patients show some improvement, the results are a little unpredictable in many cases.
Luckily, modern surgical methods have simplified the surgical intervention and helped decrease the complications associated with spine surgery. Innovations like microsurgery have helped surgeons give predictable results and perform safe surgery with minimal violation of muscles and tissues. However, as with all surgeries, there is a risk associated with spine surgery as it is very near the nerve. Nerves are delicate and can get damaged due to excess surgical handling. This is especially so when they are already under a lot of compression from the disc. But these are very rare and general consensus is that these complications occur only in about 1 % of cases.
Over 95 % of persons experience excellent relief from the symptoms of back / leg pain and numbness immediately after surgery. The relief is usually dramatic. Most people return to work in about 2 weeks after rehabilitation. As long as work is not harmful for the back, there is no need to alter lifestyle.
A section through spine showing the central spinal cord and the two nerves coming out on either side through the holes in the bone just behind the disk.
Structure of the Spinal column and the relationship of the disk to the nerve. The nerve is located directly behind the disk and is vulnerable to pressure from the front, especially when it comes out of the hole in the side.
Disc bulging and pressing on the nerve coming out of the spinal canal.