Slipped Disc – Symptoms, Treatment and Surgery

What is Slipped Disc?

Slipped disc happens when the intervertebral disc ruptures or herniates. The herniation or rupture causes the low back pain, sensory changes in the lower limbs and even immobility. Slipped disc is a common term but this condition is more appropriately known as herniated nucleus pulposus.

Image source – drapbandodkar.com

The Spine

In slipped disc or herniated nucleus pulposus, it is the spine that is primarily affected. Our spine moves like a spring when we are lifting and moving. The spine adjusts and disperses the weight by compression and expansion in situations where we lift heavy loads and when we do vigorous activities. The spring like action of the spine distributes the weight evenly, preventing the spine and its surrounding structures to be compressed. Our spine is pushed to the limits when we lift enormous loads and when we are overworked.

What Happens With Slipped Disc?

The human is made up of individual intervertebral discs; these intervertebral discs have two compositions, an outer ring made up of connective fibrous tissue, and an inner core that is gelatin like. The outer ring is hard and it protects the soft gelatin like core, this core is called the nucleus pulposus (hence the term herniated nucleus pulposus).

When the spine experiences heavy workloads (as in heavy lifting), the nucleus pulposus absorbs and distributes the load all throughout the intervertebral disc. When the load is too much, herniated nucleus pulposus happens and the soft central structure comes out of the fibrous ring. This herniation causes nerve compression, pain and inflammation.

Image Source – patient.co.uk

Symptoms and Signs of Slipped Disc

The following symptoms and manifestation may indicate you have a slipped disc of spinal disc herniation:

• Mild to severe neck and low back pain
• Pain that radiates to other areas such as the feet, knees or thighs
• Pain in the shoulder, clavicles, or jaw
• Tingling sensation in the upper or lower limbs
• Weakness of the muscles (in the back or neck)
• Paresthesia
• Possible paralysis
• Hypoactive or hyperactive reflexes
• Sciatica due to the possible irritation of the sciatic nerve
• Pulsating and/or recurrent pain
• Possible loss of bladder, bowel and sexual function

Signs and symptoms can be mild to severe depending on the area affected by the herniation. Some individuals may have no symptoms at all while some may have more pronounced manifestations.

Symptoms are usually experienced on one side of the body (unilateral), however if the herniation is large and it happens on the cauda equina on the lumbar region, then symptoms may be felt on both sides of the body. If loss of bladder and bowel control is present, the individual must seek immediate medical attention.

Causes of Slipped Disc

The following can cause or lead to slipped disc or herniated nucleus pulposus.

1. Wear and tear of the spine
2. Degeneration to the spine brought about by aging or other underlying conditions
3. Improper body mechanics while lifting
4. Lifting of heavy weights
5. Trauma
6. Poor posture
7. In some cases mutation of the genes responsible for the strength of the nucleus pulposus

Risk Factors of Slipped Disc

Certain individuals with certain conditions are at a greater risk of experiencing a herniated disc. Individuals at risk include the following:

• People who do heavy lifting such as construction workers, heavy machineries workers, and even doctors and nurses
• Prolonged sitting
• Athletes or weight lifters
• Obese or overweight individuals
• Smokers
• Workers with strenuous activities

Slipped Disc in the Neck

Slipped disc that happens in the neck is called cervical herniated nucleus pulposus. This could be a delicate condition since the neck or the cervical area is the highest region of the spine. Any damage to this area means significant loss of function of the areas below it.

This means significant nerve damage possibly brought about by a herniation can lead to paralysis or an impaired function in the parts of the body from the neck down.

Signs and Symptoms of Cervical Disc Herniation

• Mild to severe pain in the neck
• Pain while extending and flexing the neck
• Pain sneezing, straining or coughing
• Pain that radiates to the upper arm to the wrists and even fingers
• Possible weakness of the arm muscles
• Weak hand grip
• Numbness or tingling sensation in the arms and hands

Slipped Disc in the Lumbar Area

Disc hernia that occurs in the lumbar area is one of the most common types of disc herniations. Lumbar slipped disc is also one of the most common causes of lower back pain complaints in adults.

Signs and Symptoms of Lumbar Slipped Disc

• Low back pain which can be chronic or acute
• Sensory changes such as tingling and numbness of the lower extremities
• Mild to severe pain radiating to the buttocks, thighs, and feet
• Weakness of the lower extremities
• Possible paralysis

Danger symptom: Cauda equine syndrome- this involves loss of bowel and bladder control.

Diagnosis

Slipped disc can be diagnosed by implementing the following procedures:

Imaging studies such as:

1. X-rays
2. Computed Tomography (CT Scan)
3. Magnetic Resonance Imaging or MRI
4. Electromyogram and Nerve conduction studies (EMG-NCS) to diagnose nerve damage
5. Physical examination through the straight leg raise test

Treatment

Slipped disc treatment involves both non-surgical and surgical interventions. In most cases the disc hernia heals within six weeks so surgery is not done. But for cases where there is a large protrusion and nerve damage becomes a complication, surgical measures are done.

Non-Surgical Treatment

NSAIDS and Cortisone Injection

For mild cases treatment usually involves medications such as NSAIDS or Non-steroidal Anti-inflammatories. The medication treats pain and inflammation.

NSAIDS are usually taken orally but for individuals who use the medication for a long time, another mode of treatment is given. This is to prevent cardiovascular and gastrointestinal toxicity. For these individuals, cortisone injections are given to relieve the pain and other symptoms.

Ergonomics and proper body mechanics

Designing equipment and work environment in ways that it prevents back injuries and further slipped discs are advised treatments. This usually involves the use of assistive devices for lifting weight and preventing back strain. Following proper body mechanics is also an important. Lifting should follow one’s center of gravity this keeps the spine straight and disperses the weight evenly.

• Use of supportive devices on the back
• Control of weight
• Traction therapy
• Intake of Oral Steroids
• Epidural injection of cortisone

Physical Therapy

Physical therapy is usually done with other therapies. Physical therapy focuses on relieving the compression through exercise and the use of tractions. Physical therapy also prevents the possible complications.

Surgical Measures

• Chemonucleolysis– surgical procedure that dissolves the herniated nucleus pulposus
• Discectomy/ microdiscectomy- the removal of the protrusion to aid in the compression of the nerves.
• Laminectomy– spinal lamina removal that allows ample space for the compressed nerves and adjacent structures. It is usually done when a spinal stenosis is suspected.
• Hemilaminectomy– removal of a portion of the lamina
• Artificial disc replacement- this surgical procedure is done to individuals with a herniated disc due to degeneration.
• Nucleoplasty– nucleus pulposus repair
• Tessys method (transforaminal endoscopic surgical system) – this is a less invasive surgical procedure in treating disc hernia. It involves the removal of the herniated disc through small incisions in the skin where an endoscope will be inserted to view the site affected. In this type of slipped disc treatment, local anesthesia is used instead of a general anesthesia, and damage to the adjacent tissues is minimal.

Complications

When herniated nucleus pulposus is not treated appropriately, the following complication may happen:

• Cauda equine syndrome which involves an impaired bowel and bladder control
• Permanent injury to the nerves
• Paralysis and total loss of sensation to the affected limbs
• Chronic pain