What is a slipped disc?
Our spine is made up of bones stacked one on the other cushioned by discs. Every disc is made of 2 components, a soft jelly-like inner part, and a tougher and harder outer covering. When there is an injury or trauma, the inner soft jelly can be forced through the outer covering because of increased pressure. Initially, this is just a disc bulge. Later as the pressure increases, this leads to a disc protrusion. When the outer covering tears completely, there is a herniated disc, also known as a “slipped disc”. Treatment of a disc herniation includes nucleoplasty, annuloplasty or a surgery like microdissectomy.
What symptoms will I get from a slipped disc, herniated disc or disc protrusion?
The slipped disc or herniated disc can occur anywhere in your back but it is most common in the back. A slipped disc or herniated disc can lead to more pressure on the nerves leading to back pain and shooting pain down a leg.
Symptoms of a slipped or herniated disc can include:
- Pain and numbness down an arm, leg or buttock
- Pain worse with coughing, sneezing or straining during bowel or bladder movements
- Pain worse with certain movements like bending
- Pain worse after standing or sitting or walking for a short distance
- Muscle weakness and spasm
- Strange tingling, burning sensations in a body part like paraesthesia, similar to insects crawling
The symptoms from a slipped disc can vary from person to person, depending on the severity and location of the disc herniations. You should definitely see a doctor quickly or visit the Emergency Department if you have symptoms and signs of:
- increasing pain and numbness
- loss of bowel and bladder control
- difficulty with gait during walking.
How did I get a slipped disc or herniated disc?
A slipped disc can happen when the tougher outer covering of the disc is weakened or the pressure within the disc is too great like during lifting or fall or trauma. This leads to the jelly like inner portion of the disc slipping out. If it is a partial tear in the outer layer, then the disc bulges. If the tear extends, that segment of the disc protrudes. If the tear is complete, the inner segment can slip out fully in the disc herniations. In some cases the herniated disc is severe enough and moves up or down the spinal canal in what is known as an extruded disc.
Age, injury, and heavy lifting can increase the risk of a slipped disc. Disc herniation is more common in occupations that require heavy lifting. Mothers are at risk of disc herniations because hormonal changes lead to lax ligaments and the supporting muscles may not be strong enough to withstand the weight of the child that is getting heavier by the month.
Risk factors for having a slipped disc or herniated disc include being overweight. Being heavier means the disc has to cushion more weight. Having a sedentary lifestyle can also lead to weak core muscles which do little to protect the disc from herniating. Getting older is also a risk factor as the disc loses some of its water content and can slip out of position more easily. More men than women suffer from slipped disc or disc herniations.
How do I know if I have a slipped disc?
The pain specialist will ask you some questions about your pain symptoms and associated symptoms of numbness, weakness, and do a physical examination. The painful area is determined and the muscle strength and nerve function checked. The pain doctor also asks about the effects of the slipped disc on your sleep, exercise, mood, work and social functions.
He will then order some tests like an X-ray, CT scan or MRI to determine the extent of the slipped disc problem. The history given is combined with findings from the physical examination and MRI.
What is the worst case that can happen from a slipped disc?
A severe slipped disc can lead to permanent weakness, or bladder and bowel incontinence as the nerve roots at the cauda equina is injured. This is known as cauda equina syndrome, a rare but potentially catastrophic medical emergency.
Another complication from a severe, untreated slipped disc is saddle anaesthesia, with loss of sensation around your perineal region, the anus, vagina and scrotal area. This can extend to the back of the legs and around the rectum.
How to treat?
Treatment can be conservative or surgical, with pain interventions and pain injections like epidural steroid injections being an option prior to surgery. The choice of treatment depends on the severity of the symptoms and the degree of disc herniation on the MRI.
Slipped disc can be treated with physiotherapy, rest and simple medications. Core strengthening exercises can help to increase the supporting muscle strength to offload the disc and reduce the pressure on the inner part of the disc. This can help reduce the pain together with avoidance of heavy lifting and bending. Prolonged resting is discouraged as it can lead to muscle weakness and joint stiffness. Rather, patients with slipped disc should continue to walk or swim, and do stretching.
Medications that may be started if simple pain killers don’t work include medications to relax the muscles to reduce the nerve pain and nerve sensitivity like pregabalin and gabapentin and dulexetine or amitriptylline. Strong opioids should be avoided and used for the the shortest duration possible.
If the above conservative treatments do not reduce the pain from a slipped disc, it may be time to consider a pain injection or pain procedure. These include epidural steroid injection, disc nucleoplasty, or annuloplasty. Open surgery like a microdisectomy may be needed if there is a large disc herniation or if other methods are not sufficient. Microdisectomy involves cutting out the disc that has slipped out. This is done by cutting through skin and muscle to gain access to the disc and is performed under general anaesthesia.
In some cases involving disc herniation in the neck, an artificial disc may be required for disc replacement, also known as disc arthroplasty, and screws and rods placed to stabilize the spine also known as spinal fusion.
What is the prognosis?
Most people will get better within 6 to 8 weeks of conservative treatment. If symptoms of disc herniation still persist after that, it is good to consider pain injections or open surgery before the neck or back pain becomes too chronic. Chronic neck or back pain is difficult to treat, even with surgery.
I’m physically active and do a lot of exercise including weight-lifting. Is it possible to prevent a slipped disc from occurring?
Absolute prevention of a disc herniation is not possible, but you can reduce the risk of disc injury by doing the following:
- Adopt safe lifting techniques: Bend your knees instead of your waist
- Keep a healthy weight
- Change your posture every 20-30 minutes by getting up and stretching. Do not sit for too long.
- Choose exercises that strengthen the core muscles of the neck, back, as well as the legs and abdomen
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