Disc Prolapse: An Invisible Handicap

Disc Prolapse,alsoknown by different names like herniated disc, slipped disc or ruptured or bulging disc, is a problem with one of the rubbery cushions (discs) which exist between the bones (vertebrae) that stack to make your spine. A spinal disc has a soft, jellylike center (nucleus) encased in a tougher, rubbery exterior (annulus); anddisc prolapse occurs when some of the nucleus pushes out through a tear in the annulus.

Most discherniations can occur in any part of the spine, but most often occur in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra (the L4-5 and L5-S1 levels).

Cause of disc prolapse

Degenerative changes in the structure of the normal disc due to aging

Sedentary lifestyle or Obesity can cause weak back and abdominal muscles

Poor posture maintained over a prolonged period of time

Severe injury or fall

Sudden lifting of a heavyweight

Repetitive forward bending or twisting movements

Tobacco smoking leading to a degeneration of intervertebral disc (IVD)

Symptoms of lumbar disc prolapse

Many people have no symptoms from a herniated/prolapsed disc. But depending upon where the herniated disc is the symptoms vary depending upon what nerve root is being pushed. The most common symptoms of lumbar disc disease are as follows:

Intermittent or continuous back pain which becomes worse by movement, coughing, sneezing or standing for long periods of time.

Spasm of the back muscles

Sciatica painwhich starts near the back or buttock and travels down the leg to the calf or into the foot

Muscle weakness in the legs

Numbness in the leg or foot

Decreased reflexes at the knee or ankle

Changes in bladder or bowel function

Visit FirstCure Health for a diagnosis because the symptoms of lumbar disc looks like other conditions or medical problems.

Types of disc prolapses

Bulging disc:

With age, the intervertebral disc loses fluid and become rigid. Bulging or protruding disc occurs when the inner ring or the spongy disc (located between the bony parts of the spine and acting as a ‘shock absorber’) becomes compressed. This may lead to the breakdown of tougher outer ring (annulus fibrosus) and the inner discbulges out, thus called a bulging disc.

Herniated or ruptured disc:

When the tough annulus fibrosus ruptures with continued stress on the spine and the nucleus pulposus comes out of the annulus fibrosus, then the condition is called a ruptured or herniated disc. The free fragments of the disccan compress the surrounding structures such as nerve rootsleading to pain radiating down the arm or leg (sciatica), weakness, numbness or changes in sensation. Disc herniations are commonly seen especially on the MRIs, but these findings might not correlate with the clinical symptoms.

Diagnosis

At FirstCure, the Orthopedic Surgeon will first perform a thorough physical examination and may ask you questions about your medical history and lifestyle. After physical examination, the doctor will recommend certain imaging tests like:

X-ray a test to see images of bones onto a film.

Myelogram, a procedure where dye are injected into the spinal canal to make the structure clearly visible on X-rays.

Magnetic resonance imaging (MRI) where an imaging procedure uses X-rays and computer technology to produce horizontal or axial images (often called slices) of the body showing detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

Electromyography (EMG) is atest which measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle.

Treatment / Management

After the diagnosis at FirstCure Health’s,we advise conservative therapy as first line of treatment to manage lumbar disc disease. The first step in treatment is to reduce pain and reduce the risk of further injury to the spine by correcting muscular imbalances, joint malalignment and postural deviations by including a mix of the following:

Bed rest

Education on proper body mechanics (to help decrease the pain or damage to the disc)

Physical therapy which may include massage, conditioning and exercise programs

Weight control

Use of a lumbosacral back support

Medicine to control pain and relax muscles

If these measures fail, surgery is performed to remove the herniated disc. This surgery is done under general anesthesia. Your surgeon will make an incision in your lower back over the area where the disc is herniated. Some bone from the back of the spine may be removed to gain access to the disc. Your surgeon will remove the herniated part of the disc and any extra loose pieces from the disc space.

After surgery, you may be restricted from activity for a few weeks while you heal to prevent another disc herniation. Your surgeon will discuss any restrictions with you.