Also known as slipped disc, herniated disc or sciatica. The discs are the shock absorbers of your spine. When they are injured the inner soft part of the disc can protrude out through a tear in the outer lining of the disc. This disc material can press on the nerves in the spinal column, injuring them through direct pressure and causing inflammation.
The most common age to develop a disc prolapse is between the ages of 30-50 years., twice as many men as women are affected. Prolpased discs occur mainly in the low back (lumbar) spine. Less than I in 20 cases of back pain are due to a disc prolapse, most are due to mechanical back pain. (see section back pain).
A slipped disc is characterised by sudden, severe back pain that is often made worse by movement and which can usually be eased by lying down flat.
Nerve root pain (sciatica) can also occur because a nerve is trapped or irritated by a prolapsed disc. Although the problem is in the back, patients experience pain along the course of the nerve, for example, down a leg to the calf or foot.
With a prolapsed disc, the sciatic nerve is most commonly affected. The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back and travels down each leg. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.
In rare cases, cauda equina syndrome can occur. This is a disorder where the nerves at the very bottom of the spinal cord are trapped. It can cause low back pain as well as problems with bowel and bladder function and weakness in one or both legs. These symptoms need urgent medical treatment to prevent permanent damage to the nerves that supply the bladder and bowel.
A large number of people can have a prolapsed disc without any symptoms if it doesn’t trap or irritate the nerve.
A doctor will normally be able to diagnose a prolapsed disc from the symptoms and by examining the patient.
In most cases, no tests are needed, as the symptoms often settle within a few weeks.
Tests such as x-rays or scans may be advised if symptoms persist. In particular, an MRI scan can show the site and size of a prolapsed disc. This information is needed if surgery is being considered
Painkillers should be taken on a regular basis to provide effective relief and allow you to stay active. The condition is characterised by pain, inflammation and muscle spasm. A cocktail of medicines may be needed to address all the features of the problem. It is recommended to take a painkiller such as paracetamol, or codeine. If this does not help your doctor can prescribe stronger analgesics as needed. Also it is important to take an anti-inflammatory such as Ibuprofen and if there is marked muscle spasm a muscle relaxant such as diazepam. You will need to see your doctor who can tailor your drug treatment for the condition.
Patients can visit a physiotherpist, osteopath or chiropracter for this condition, in the early stages it can be too painful to have manipulative treatments.
Most cases of prolapsed disc will settle after 6 weeks. If the pain does not settle is difficult to control, is associated with significant weakness in the legs then surgery is an effective treatment.
If you have features of cauda equina syndrome where there is pain and weakness in one or both legs associated with difficulty passing water or going to the toilet then this will require urgent surgery.
The operation is called a microdisectomy. It is usually a keyhole technique where the prolapsed fragment of disc is removed, thus relieving the pressure on the trapped nerves. It is a very effective treatment.
Some patients will benefit from physiotherapy treatment at the outset of a prolapsed disc. The treatment is aimed at alleviating pain and swelling and reducing compensatory muscle spasm. Taping techniques can be used to try to alleviate pressure and ultrasound can be used to attempt to reduce swelling. Acupuncture and gentle massage is often also beneficial in reducing compensatory muscle spasm. Once the acute symptoms settle, an exercise programme will be recommended. The programme will be aimed at strengthening the core back muscles which will in turn reduce some of the stresses going through the vertebra. Patients are given advice on back care and posture. Work station/ergonomic set ups are often discussed and advice is given.