A Simple Guide to Prolapsed Intervertebral Disc

A Simple Guide to Prolapsed Intervertebral Disc
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What is Prolapsed Intervertebral Disc?
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Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).

It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.

What are the causes of Prolapsed Intervertebral Disc?
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1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.

2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.

3.Spinal tumour rarely pushes the disc out of its intervertebral space

What are the symptoms and signs of Prolapsed Intervertebral Disc?
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Symptoms:
1.Low Backache with pain in the lumbar region

2.Sciatica or pain shooting down 1 leg

3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing

4.Pain may so bad that the person cannot stand erect.

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:
1.Muscle spasm especially spinal extensor muscles

2.Movement of the back and affected led painful and restricted

3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side

4.Straight leg raising test is usually restricted on the affected side.

5.Neurological signs such as paraesthesia commonly present on the affected side.

6.Sensory and motor deficit may be present in the affected side

7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished

L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes

S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished


How to investigate the cause of Prolapsed Intervertebral Disc?
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1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,

2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test

3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,

4.MRI of spine for slipped disc

5.bone scan for osteoporosis

A definite diagnosis can then be made and the cause of the pain treated.


What is the Treatment of Prolapsed Intervertebral Disc?
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Conservative treatment:
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Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy

Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles

Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain

Surgery:
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Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI

Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc

Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.

What is the prognosis of Prolapsed Intervertebral Disc?
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Prognosis depends on the underlying cause.

Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.

What is the Prevention of Prolapsed Intervertebral Disc?
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Avoidance of postural strain on the back

Wear a corset

Exercises to strengthen the back muscles.