Slipped Disc, Disc prolapse, Sciatica, Disc Degeneration

Lumbar and Cervical discs are prone to degeneration and prolapse due to their secondary acquired curvatures.
Each disc consists of Outer Annulus, and Inner Nucleus pulposus. As annulus becomes weak, or becomes degenerative, or ruptures secondary to an injury; the nucleus pulposus material extrudes into the spinal canal or the nerve root region. This produces pressure on the nerves producing Sciatica like symptoms.

Technically called a Prolapse Intervertebral disc syndrome; traditionally, it has been labelled as Slipped disc.
A disc protrusion can produce pressure on the spinal cord itself, or on one of the exiting nerve roots producing the typical symptoms.

Treatment of a herniated disc depends on a number of factors including:
•Symptoms experienced by the patient
•Age of the patient
•Activity level of the patient
•Presence of worsening symptoms or neurologic deficit

More than 90 percent patients of new onset Sciatica or disc prolpase, can be satisfactorily treated without surgery. However, there is small chance of recurrence.
Activity and lifestyle modification is important to prevent recurence.

A word of caution to be remembered in such cases: Any patient with neurologic deficit, or worsening pain despite adequate conservative trial, or those presenting with loss of bladder/ bowel control are candidates with significant pressure on the spinal cord or the exiting nerve roots.
Such patients MUST seek Orthopedic opinion, and may require surgical intervention.

Slipped Disc Affecting Young IT Professionals

for queries, pl contact

Dr Anurag Awasthi  Orthopaedic Specialist, Sohna Road, Gurgaon 9718112112

A young IT professional presented to my clinic yesterday, with complaints of acute onset backache for 1 week, which often goes down his Right leg, and some funny sensations over his sole of feet. He remembered having worked overtime to meet deadlines, often slumping in his office chair, and constantly focusing on his computer screen.
He did not really give me a history of having done some sort of weight lifting. But he confessed, that he could not follow any exercise regimen due to work pressure.

I asked for an X-ray, which showed signs of muscle spasm in his lower back. I ordered for an MRI of the lower back. His MRI showed bulge of the inter-vertebral disc at L4-L5 (between 4th and 5th Lumbar vertebra of the lower back). His symptoms were readily explained with the finding.

The question is why did it all happen?

Prolapse Inter-vertebral Disc Syndrome or Slipped Disc, as we commonly call it; is a very common disorder affecting young population. A little insight into the cause- Our spine has vertebra aligned on top of each other with a cushion like substance called Inter-vertebral disc in between the vertebrae. The spinal cord and nerves pass along the back of vertebral bodies, encased in a well formed bony column. If the disc crosses its normal circumference, it may produce pressure on the spinal cord or the nerves producing so called Sciatica.

Usually a patient gives history of sudden jerk, or lifting weights; but sometimes it may happen without an obvious precipitating factor. The usual contributing factor include- Poor muscle tone, Abnormal posture while sitting, or lifting objects. Cigarette smoking whether active or passive increases the propensity and severity of a disc prolapse.

Acute disc prolapse should initially be treated with a short period of rest, followed by supervised physiotherapy, and modification of activity. In patient presenting with severe pain not responding to conservative plan, the bulging portion of the disc is removed through surgery; or it may be decompressed by thermal-coagulation.

Surgery is mandatory for patients presenting with a neurological deficit in the area of nerve supply. Ozone therapy is a new modality, with specific indications and less predictable results.

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