Prolapsed Intervertebral Disc is the technical term for what is more commonly known as a slipped disc. These intervertebral discs are located between each of the vertebrae of the spine, and act as cushions or shock absorbers as well as help keep the spine flexible.
These discs are made up of a circle of tough, fibrous connective tissue with a central, gel-like core. Located at the centre of this column of vertebrae and discs is the spinal cord, which stretches from the brain stem to the lower back. There are nerve root connections to the rest of the body located between each of the vertebrae.
What is a Prolapsed Intervertebral Disc (Slipped Disc)?
A prolapsed intervertebral disc occurs when the tough, fibrous outer part of the disc ruptures, which allows the gel-like core to bulge and protrude outwards. This damaged disc can then put pressure on the spinal cord or on a single nerve fiber.
This means that not only can a slipped disc cause pain in the area of the disc, but also in the area that the nerve controls, such as an arm or leg. It should be noted that “slipped disc” is something of a misnomer, as the disc is unable to slip or slide. Although a slipped disc can occur anywhere along the spine, it most often occurs in the lower back, between the fourth and fifth vertebrae.
Causes of Prolapsed Intervertebral Disc (Slipped Disc)
It is not always obvious what causes the tough, fibrous connective tissue of the disc to break down. A slipped disc can simply be the result of getting older, as the discs lose their water content with age, making them less flexible and more likely to rupture. However, there are other factors that can put undue pressure on your spine and cause a rupture, such as bending awkwardly, working a job that has repetitive bending and lifting, working a job that involves a great deal of sitting, especially driving, being overweight, participating in weight-bearing sports like weight lifting, or having been through a traumatic injury, such as a road traffic accident or a fall.
In some cases, a person will have no symptoms. If symptoms occur, they are often due to pressure on the nerves. Common symptoms can include:
Numbness and tingling: This occurs in the region of the body that the nerve supplies.
Weakness: This tends to occur in the muscles linked to the nerve, which may cause stumbling when walking.
Pain: This occurs in the spine and can spread to the arms and legs.
If the herniated disk is in the lower back, the pain often affects the buttocks, thighs, calves, and, possibly, the feet. This is often referred to as sciatica because the pain travels along the path of the sciatic nerve.
If the problem occurs in the neck, the shoulders and arms normally experience the pain. Quick movements or sneezing might induce shooting pains.
Diagnosis of Prolapsed Intervertebral Disc (Slipped Disc)
If you suspect that you have a slipped disc, your doctor will be able to make a diagnosis from your medical history, symptoms and a physical examination. Your doctor may test your reflexes, walking ability, muscle strength and the sensation in your arms and legs.
This is generally enough to diagnose a slipped disc, but if your doctor needs to be sure or you’re still having symptoms after four to six weeks, he may order a CT scan or an MRI.
Treatment options include medication, therapy, and surgery.
Over-the-counter medication (OTC): Ibuprofen- or naproxen-based drugs can help with mild to moderate pain.
Nerve pain medications: Medications for treating nerve pain include gabapentin, pregabalin, duloxetine, and amitriptyline.
Narcotics: If OTC medications do not relieve discomfort, a doctor might prescribe codeine, a combination of oxycodone and acetaminophen, or another type of narcotic. Side effects include nausea, sedation, confusion, and constipation.
Cortisone injections: These can be injected directly into the area of the herniation to help reduce inflammation and pain.
Epidural injections: A doctor injects steroids, anesthetics, and anti-inflammatory medications into the epidural space, which is an area around the spinal cord. This can help minimize pain and swelling in and around the spinal nerve roots.
Muscle relaxants: These help reduce muscle spasms. Dizziness and sedation are common side effects.
Physical therapists can help find positions and exercises that minimize herniated disk pain.
Therapists may also recommend:
• Treatment with heat or ice
• Ultrasound, which uses sound waves to stimulate the affected area and improve blood flow.
• Traction, which can alleviate pressure on the affected nerve.
• Short-term bracing for the neck or lower back, to improve support.
• Electrotherapy, as electric impulses might reduce pain for some people.
If symptoms do not improve with other treatments, if numbness persists, or if bladder control or mobility worsen, the treating doctor might recommend surgery.
In most cases, the surgeon removes only the protruding portion of the disk. This is an open discectomy.
The surgeon will usually conduct open discectomy using a laparoscopic technique, opening a small hole in either the front or back of the spine.
This technique avoids the need to remove small portions of the vertebrae or to move the spinal nerves and spinal cord to access the disk.
Below the waistline, the spinal cord separates into a group of individual nerves, collectively called the caudaequina or “horse’s tail.” In rare instances, a herniated disk can compress this entire set of nerves.
This can cause permanent weakness, paralysis, loss of bowel and bladder control, and sexual dysfunction. If this occurs, emergency surgery is the only option.
Seek medical advice if
• There is any bladder or bowel dysfunction.
• The weakness progresses and prevents normal activities.
• There is increasing numbness around the inner thighs, the backs of the legs, and the rectum.
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