Disc Prolapsed / Sciatica

When you have a prolapsed disc (commonly called a slipped disc), a disc does not actually slip. What happens is that part of the inner softer part of the disc (the nucleus pulposus) bulges out (herniates) through a weakness in the outer part of the disc. A prolapsed disc is sometimes called a herniated disc. The bulging disc may press on nearby structures such as a nerve coming from the spinal cord. Some inflammation also develops around the prolapsed part of the disc.

Any disc in the spine can prolapse. However, most prolapsed discs occur in the lumbar part of the spine (lower back). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.

The most common age to develop a prolapsed disc is between 30 and 50 years. Twice as many men as women are affected.

Symptoms of Slipped Disc

Causes of disc prolapse:
It is not clear why some people develop a prolapsed disc and not others, It seems that some people may have a weakness in the outer part of the affected disc. Various things may trigger the inner softer part of the disc to prolapse out through the weakened outer part of the disc. For example, sneezing, awkward bending, or heavy lifting in an awkward position may cause some extra pressure on the disc. In people with a weakness in a disc, this may be sufficient to cause a prolapse. Factors that may increase the risk of developing a prolapsed disc include: a job involving lots of weight lifting, a job involving lots of sitting (especially driving), weight-bearing sports (weight lifting, etc), smoking, obesity, and increasing age (a disc is more likely to develop a weakness with increasing age).

Symptoms of a slipped disc

1. Back pain:
The pain is often severe, and usually comes on suddenly. The pain is usually eased by lying down flat, and is often made worse if you move your back, cough, or sneeze.

2. Nerve root pain (usually sciatica):
Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on (trapped) by a prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc. Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Therefore, you may feel pain down a leg to the calf or foot. Nerve root pain can range from mild to severe, but it is often worse than the back pain. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. (The term sciatica means nerve root pain of the sciatic nerve.) The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back. It travels deep inside the buttock and down the back of the each leg.

3. Other nerve root symptoms:
The irritation or pressure on the nerve next to the spine may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. The exact site and type of symptoms depend on which nerve is affected.

4. Caudaequina syndrome:
Caudaequina syndrome is a particularly serious type of nerve root problem that can be caused by a prolapsed disc. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. See a doctor immediately if you develop these symptoms.

3. Other nerve root symptoms:
The irritation or pressure on the nerve next to the spine may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. The exact site and type of symptoms depend on which nerve is affected.

4. Caudaequina syndrome:
Caudaequina syndrome is a particularly serious type of nerve root problem that can be caused by a prolapsed disc. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. See a doctor immediately if you develop these symptoms.

Treatment of slipped disc

Exercise and keep going
Continue with normal activities as far as possible. This may not be possible at first if the pain is very bad. However, move around as soon as possible, and get back into normal activities as soon as you are able. As a rule, don’t do anything that causes a lot of pain. However, you will have to accept some discomfort when you are trying to keep active.

Medication
If you need painkillers, it is best to take them regularly. If you take them regularly the pain is more likely to be eased for much of the time and enable you to exercise and keep active.

  • Paracetamol is often sufficient if you take it regularly at full strength. For an adult, this is 1000 mg (usually two 500 mg tablets), four times a day.
  • Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac need a prescription. Some people with asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatories.
  • A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. This may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre or use laxatives.
  • A muscle relaxant such as thiocolchicoside is sometimes prescribed for a few days if the back muscles become very tense and make the pain worse.

Spine Procedures
Many procedures are to be done for relief of pain, tingling and numbness due to slipped or prolapsed disc. This procedures are help to reduce the inflammation and swelling around the nerve root and prolapsed disc.

  • Transforaminal Epidural Procedure
  • Interlaminar Epidural Procedure
  • Caudal Epidural Procedure

This all procedures are done in operation theater under continuous x-ray ( IITV ) guidance. All procedures are done under Local Anaesthesia so this is called ” Day Care Procedure ” and patients can be discharge on same day after completion of procedure.

Endoscopic Disc Removal :
This is a newly invented technique in which prolapsed or slipped disc is to be remove through a small endoscope which is inserted in body with a very small less than 1 cm size cut. It is also done under Local Anaesthesia under continuous x-ray guidance and direct vision through the endoscope. This is also a ” Day Care Procedure ” so no need to stay more than 1 day in hospital. Results of endoscopy disc removal procedure are more promising & more long lasting as we are not reducing the swelling or edema but  actually remove the part of disc which is slipped or prolapse and compression on nerve root is gone, so patient get immediate relief of symptoms like pain, tingling and numbness in legs.

Ozone Discectomy (Ozonucleolysis)
Injection of Ozone-Oxygen mixture into the disc is a new alternative method of treating patients suffering from back and leg pain (sciatica) caused by disc prolapse. Large number of international studies confirms the efficacy of this treatment and superiority of this treatment over conventional disc surgery.

Radiofrequency Ablation
Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. RFA can be used to help patients with chronic (long-lasting) low-back pain. RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications