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Herniated disc (Slip Disc)

A herniated ( prolapsed ) disc commonly known as slip disk occurs when the outer fibres of the intervertebral disc are injured or harmed. The intervertebral disk is a soft cushion material ( also known as the nucleus pulposus) that ruptures out of its enclosed space i.e its normal boundaries and irritates the spinal nerves causing pain and numbness.

Herniated discs ( slip disk ) are very common in young and middle-aged adults. It rarely occurs in children. The herniation can develop suddenly, or gradually over a period of time, probably weeks or months.

Most of the time, (as much as 90 percent of cases) disc herniations can be treated with non-operative treatment. A few patients with disc herniation may require surgery in the form of Microdiscectomy (microscopic surgery to remove the herniated disc)

What causes herniated discs ?

As mentioned earlier, the herniated disk can develop

  • a) Suddenly or
  • b) gradually over a period of time, probably weeks or months

a) Jotting down a few scenarios on how herniated disk can develop suddenly due to a shock or pressure unable for the disk to handle:

  • 1. Falling from a significant height
  • 2. Landing on your buttocks
    The above can transmit a huge amount of pressure across the spine. If the pressure is strong enough it can cause the vertebra bone to fracture, or lead to an intervertebral disc rupture i.e slip disk.
  • 3. Bending or leaning forwards places substantial stress on the intervertebral discs. If you bend and attempt to lift an object which is too heavy, this force may cause a disc to rupture.

b) Herniated disks are also a result of weakening outer fibres of the disk. This is usually due to repetition in minor injuries which accumulates and builds up over time

The damage may also occur due to:

  • 1. Ageing
  • 2. hereditary factors
  • 3.work- or recreation-related activities. Often there is no obvious reason why such a process should have occurred.
  • 4.Lifting weights leading to Twist in a manner which puts enough pressure on the disc leading it to rupture through its weakened outer fibres.
  • 5.Smoking
  • 6.Obesity
  • 7.Sitting Job ( Like driving )

Most common symptoms associated with slip disc are:

  • a) Back Pain : The back pain if experienced by the patient is often severe and usually occurs suddenly. The pain is usually eased by lying still and is often made worse on sitting and moving. Under such scenarios, even cough and sneeze may give severe pain in the back.
  • b) Neck pain : Patients with slip disc in the cervical spine will complain of neck pain

Main symptoms of a herniated disk ( slip disk )

  • a) Nerve root pain (usual sciatica): Nerve root pain occurs because of a nerve coming from the spinal cord being pressed on since trapped by a 'slipped' ( herniated ) disc, or is irritated by the inflammation caused by the herniated disc.
  • b) It may also lead to loss of control of bladder bowel movements ( Cauda equina syndrome - it is rare in nature but needs immediate medical attention)
  • c) numbness in the genital area and impotence ( in men )
  • d) The irritation caused by the nerve that's trapped by the spine may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. The exact location and type of symptoms depend on which nerve is affected.
  • e) Pain flowing down one or both arms or legs
  • f) Weakness in arms and legs

What is the diagnosis for Herniated Disk ( Slip Disk ) ?

  • 1. Doctors Examination: The doctor can identify a herniated disk with the help of the symptoms and thorough examination. In order to confirm the correct diagnosis, the following may also be required :
  • 2. X-ray
  • 3. CT-Scan
  • 4. MRI Scan - This is the most accurate test to diagnose the problem.

In order to examine thoroughly: the doctor may ask for the following questions :

  • a) Did the patient have an injury before the pain started?
  • b) The exact location of the pain?
  • c) Is there any numbness or pins and needles feeling?
  • d) Feeling of weakness?
  • e) Did the patient face a similar problem before?
  • f) Signs of weight loss, high temperature ( fever ) , or other recent illnesses?

Treatment For Slipped Disc

At Pune Spine Institute, 80 or 90% of patients suffering from slip disc feel better with non operative treatment and symptoms almost disappear. Typically the healing process takes 6-9 weeks, however depending on the situation, it may take longer.

Medication : During the ‘keep going’ period of 6-9 weeks the patient might face pain and thus a right kind of pain medicines might be prescribed depending upon the severity of the condition and the pain experienced by the patient

Physiotherapy : Exercise under observation of a skilled spine physiotherapist plays a vital role in treatment of patients with herniated disc. Exercise can help in lowering the pain by strengthening the muscles that support the spine. At Pune Spine Insititute, the exact nature and intensity of the exercises is tailor made according the individual patients condition

Epidural injections/ nerve root blocks : An epidural is an injection given into the area in the back around where the sciatic nerve comes out of the spine. This reduces the inflammation around the nerves thereby reducing pain and makes recovery form the slip disc more comfortable

Surgery

Surgery may be recommended in some cases. As a thumb rule, surgery may be considered only if the symptoms are very severe and have not settled during the keep going period of 6-9 weeks. The surgeries are performed in very rare cases. About 9 out of every 10 patients with a herniated disc, are treated without surgery.

The goal of the surgery is to remove the herniated part of the disc and release the pressure of the nerves which are causing the symptoms. At Pune Spine Institute, the preferred surgical technique is Microdiscectomy (Microscopic removal of herniated disc fragment) which is a minimally invasive surgery and gives rapid relief from pain. Depending on the nature of work, Patients can return to work within 2 to 3 weeks of surgery