Disc prolaspe, (slipped disc) Herniated Disc

by James O'Sullivan

The intervertebral discs are thin, oblong structures in the spine that serve as cushions between the vertebrae. Each disc is made of a soft gel core surrounded by a tough, fibrous outer shell. This structural pattern allows the disc to be firm enough to maintain the space between the vertebrae, but soft enough to compress when the spine flexes during bending, leaning and turning sideways.

In some people, mostly middle-aged adults, a disc's tough outer shell develops an area of weakness or a small tear. When this happens, part of the disc's soft inner core can bulge out of its normal position (herniate), producing a condition called a disc prolaspe or herniated disc. If the herniated disc presses on nerves in the nearby spinal canal, this can cause variety of nerve-related symptoms, including pain, numbness and muscle weakness. In the most severe cases, a herniated disc can compress nerves that control the bowel and bladder, causing urinary incontinence and loss of bowel control.

Affected Areas

There are three distinct areas of the vertebral column where a herniated disc may occur:

• The cervical area between the vertebrae in the neck

• The thoracic area between the vertebrae in the upper back, near the ribs

• The lumbar region between the vertebrae in the lower back, above the pelvis

Herniated discs are most common in the lumbar region. They are relatively rare in the thoracic region, where they account for only one in every 200 to 400 disc herniations.

Cause:

It is not fully understand the reasons why discs herniate. Most theories attribute this condition to a combination of the following factors:

• Disc aging — Herniated discs are rare in young people, but are common among people aged 35 to 55. Of all the factors responsible for herniated discs, aging is probably the most important. With age, the disc's outer shell appears to degenerate slowly, possibly because of decades of upright posture and back flexion.

• Genetic factors — In some families, several close relatives suffer from herniated discs, whereas other families are not affected at all. If the condition runs in a family, it may have an unusually early onset, even striking people younger than 21. Studies are beginning to identify specific genes linked to inherited forms of disc disease.

• Individual risk factors — You may be at increased risk of a herniated disc if you work at a job or participate in a sport that involves heavy lifting or excessive twisting or bending.

Symptoms

The first symptom is usually back pain in the area of the affected disc. Some researchers believe that this pain is a signal that a disc's tough outer shell has been injured or weakened, not necessarily that the inner core has herniated. If the inner core does herniate and press on a nearby nerve, the resulting symptoms vary depending on the location of the herniated disc:

·                     Herniated disc in the cervical region — There can be pain in the neck, shoulder, shoulder blade, arm or chest, together with numbness or weakness in the arm or fingers. If the pain is centered in the chest and arm, it can mimic the chest pain of heart disease. Occasionally, frequent urination and headaches can occur.

·                     Herniated disc in the thoracic region — Symptoms tend to be vague, misleading and long lasting. There may be pain in the upper back, lower back, abdomen or legs, together with weakness and numbness in one or both legs. Some affected people also complain of bowel or bladder incontinence.

·                     Herniated disc in the lumbar region — Many people with herniated discs suffer from years of intermittent and mild lower back pain before a single triggering event (heavy lifting, sudden bending, abrupt twisting) aggravates their symptoms to the point that they seek medical attention. It also may develop without an identifiable triggering event. In most patients with a lumbar-disc herniation, severe leg pain is the chief complaint. This leg pain is called sciatica because it comes from pressure on the sciatic nerve. It usually begins in the lower back, then spreads into the buttocks and down the back of one thigh and leg. Sciatica typically becomes worse if the patient coughs, sneezes, bears down or moves the back abruptly. While often relieved by rest, sciatica may become worse with driving or lifting. In addition, there may be numbness, tingling or muscle weakness in the buttocks or leg on the side of the pain. In rarer and more severe forms of lumbar-disc herniation, the nerve is compressed more extensively. If this happens, additional symptoms can develop, including rectal pain, loss of bowel and bladder control, and numbness around the genital area, buttock’s or backs of the thighs.

Diagnosis

• History of milder episodes of back pain.

• Location: Is it limited to your back, or does it spread into your shoulder, arm, chest, buttock or leg?

• Onset: When did your pain start? Did it begin when you tried to life something heavy, or was it triggered by a sudden twist or bend of your back?

• Relieving factors: What makes it feel better

• Exacerbating factors: what makes it worse?

• Periodicity: Does the pain disappear when you rest the affected area, or is it present even at rest?

• Associated features: Have you noticed any areas of numbness, tingling or muscle weakness in your arms or legs?

• Associated features: Are there problems with bowel or bladder control, rectal pain or numbness in the buttocks or genital area?

• Tests to rule out cancer or a bone infection of the vertebrae.

• General physical exam:  numerous tests to check left and right diff. A straight leg raising test. Neurological examination.

• Spinal X-rays, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be recommended if your initial diagnosis is not clear,

• An electromyography (EMG), a test that analyzes muscle and nerve function to identify sites of nerve compression or irritation.

Treatment

• Limited bed rest (generally no more than a day or two)

• warm baths, heating pads

• medications, such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. Some physicians will prescribe oral corticosteroids.

• An moderate exercise regimen. Even at the early stage.

• ultrasound,

• massage

• acupuncture.

• Epidural steroid injections in sever cases

• Surgery if evidence of progressive nerve damage (lost bowel or bladder control)

Prevention

In many cases, it is not possible to prevent a herniated disc. However, if you have suffered from a herniated disc in the past, you may be able to decrease your chances of it happening again by:

• Avoiding activities that require heavy lifting or repetitive bending

• Practicing good posture

• Maintaining a healthy weight

• Following a physical-therapy program aimed at building muscle strength in your back and improving abdomen and back flexibility.

• Exercising regularly, especially swimming and walking.

When To Call A Professional

If you develop severe back pain, especially if you also have pain or numbness in your arms or legs or if you lose control of your bowels or bladder.

Prognosis

About 60 percent of patients respond to conservative therapy within one week, and 90 percent to 98 percent respond within six weeks. Surgical intervention has a high success rate when an MRI or CT demonstrates that the cause of the symptoms can be corrected.

Note: You should seek medical advice for any medical condition that you are interested in. These notes are intended for information purposes only and should not be used as a substitute for face to face medical advice......

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james@active-health.org