The vertebral column (also called the spinal column orbackbone) is made up of 33 bones known as vertebra (plural, vertebrae). Each vertebra is separated from the adjacent vertebrae by intervertebral discs, a spongy but strong connective tissue. The intervertebral discs, along with ligaments and facet joints, connect the individual vertebrae to help maintain the spine’s normal alignment and curvature while also permitting movement.
Lumbar spine – usually consists of five vertebrae in the lower back.These vertebrae are the largest because they withstand the greatest amount of force in the spine. The lumbar spine is also more mobile than the thoracic spine. Because of these factors, the lumbar spine is the most frequently affected by degenerative conditions, spinal stenosis, and herniated discs.
A herniated disc represents a “rapid model” of nerve compression and occurs when the fibrous outer portion of the disc ruptures or tears, and the jelly-like core squeezes out. When the herniated disc compresses a nearby nerve,as in the video, the result can be a pinched nerve. A pinched nerve may cause pain, numbness, tingling or weakness in the legs. The substance that makes up the disc’s jelly-like core can also inflame and irritate the nerve, causing additional pain.
What are the symptoms?
A lumbar herniated disc may cause the following symptoms :
- Intermittent or continuous back pain (this may be made worse by movement, coughing, sneezing, or standing for long periods of time)
- Spasm of the back muscles
- Sciatica —radiating pain that 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
- Changes in bladder or bowel function
- Difficulty walking
The symptoms of disc disease may resemble other conditions or medical problems. Always consult a doctor for a diagnosis.
Causes and Risk Factors :
- Herniated discs can often be the result of degenerative disc disease. As people age, the intervertebral discs lose their water content and ability to cushion the vertebrae. As a result, the discs are not as flexible. Furthermore, the fibrous outer portion of the disc is more likely to rupture or tear.
- Acute disc herniations can occur in young, healthy people as a result of an injury or tear to the outer layer of the disc (called the annulus fibrosis) that allows the central, jelly-like portion of the disc (called thenucleus pulposis) to herniate into the spinal canal or foramen.
How are at risk ?
- The commonest age group is 25 to 40 when the disc starts degenerating (weakening) and the activity levels are high. The profile of patient at risk is an obese, sedentary individual that occasionally indulges in unaccustomed strenuous activity at one end of the spectrum versus an individual who indulges in strenuous activities that challenges the mechanical endurance of the back.
Tests and Diagnosis :
If a patient presents with symptoms of slip disc, he may require the following diagnostic procedures:
- Magnetic resonance (MR) imaging – the best overall method of imaging the spinal cord, nerve roots, intervertebral discs, and ligaments.
- Electromyography (EMG) – tests the electrical activity of a nerve root to help determine the cause of pain.
Since a herniated disc may cause similar symptoms to other degenerative spinal conditions, a surgeon may order a variety of diagnostic procedures to rule out other possible conditions.
Treatments- does it requires surgery always?
Not always. Majority of the slip discs can be managed conservatively simply by –
- Medications (to reduce inflammation, control pain and/or relax muscles)
- Epidural injections/ Blocks.
Enforced complete bed rest reduces the force on the injured disc allowing it to heal over 3-6weeks. Once pain control reaches tolerable limits, early resumption of graduated activity and exercise is necessary.
Surgical treatment for a herniated disc will be based on the following :
The history, severity and duration of pain
Whether or not the patient has received previous treatments for disc disorders and how effective the treatments were
Whether or not there is any evidence of neurologic damage such as sensory loss, weakness, impaired coordination, or bowel or bladder problems
Surgery for patients with disc disorders of the spine is usually recommended for those patients who do not find relief with non-operative treatment over a period of 6-12 weeks. Surgery is also recommended in patients who have a neurologic deficit (numbness, weakness or reduced function due to pressure on the spinal cord or nerves). Early intervention in those cases is best in order to maximize the likelihood of neurologic recovery.
What and how will be the surgery done?
Microdiscectomy – Minimally invasive or key hole surgery.
A procedure that uses a microscope and microsurgical tools to remove the portion of the disc that is pressing against the nerve, relieving the pressure caused by a herniated disc. The aim is to remove loose fragments enough to free the nerve and cause relief of pain. The annulus (disc covering) heals naturally allowing normal activity.
This procedure is performed under general anesthesia through a small skin incision over the spine.
How long will I have to stay in the hospital?
- Just 1 Day.
Bed rest for how long?
- Post surgery no bed rest is required. The patient is made to walk the same day and is discharged the other day.
How much disc is removed?
- Only the portion of the disc that is herniated is removed. This decompresses the nerve and gives pain relief. The rest of the disc is kept intact. The hole in the disc heals naturally.
Can there be a recurrence?
- The surgery aims to control pain through a keyhole incision. However it does not strengthen or weaken the spine. There is a chance of recurrence if an uncontrolled activity tears the disc. Increasing core muscle strength by exercise is the best protection against a recurrence.
Is this a safe procedure?
- This is a safe and effective surgery that allows immediate restoration of activity. The chances of nerve injury are minimized by use of a microscope. The complication rate can be placed at 1% or less.
Can I lead a normal life after a disc surgery?
- Disc surgery does not refrain a person from pursuing a normal lifestyle. However, like any other machine, the spine also needs maintenance. For any machine to function optimally the load on the machine (body-weight) should reduce and it should be serviced (core-strengthening exercises) regularly.