A Simple Guide to Prolapsed Intervertebral Disc

A Simple Guide to Prolapsed Intervertebral Disc
---------------------------------------------------------------

What is Prolapsed Intervertebral Disc?
-------------------------------------------------------

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?
---------------------------------------------------------------

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?
-----------------------------------------------------------------------------

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?
----------------------------------------------------------------------------

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?
----------------------------------------------------------------------------------

Conservative treatment:
-----------------------
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:
-----------------------
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:
--------------
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?
-------------------------------------------------------------------------

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?
----------------------------------------------------------------

Avoidance of postural strain on the back

Wear a corset

Exercises to strengthen the back muscles.

A Simple Guide to Sciatica

A Simple Guide to Sciatica
-----------------------------------------

What is Sciatica?
----------------------------------

Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.

What are the causes of Sciatica?
------------------------------------------------

Sciatica occur as a result of pressure on the sciatic nerve as a result of:

1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae

2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve

3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves

4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve

5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.

6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve

7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.

8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.

What are the symptoms and signs of Sciatica?
------------------------------------------------------------

Symptoms:

1.pain may be a continous dull ache in the leg or a shooting pain down the leg

2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle

3.Pain is usually but not always relieved by rest(lying flat)

4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:

1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.

2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted

3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression

What are the investigations required in Sciatica?
------------------------------------------------------------

1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours

2.MRI of lumbar spine

3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis

What is the treatment of Sciatica?
-----------------------------------------------------

Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy

5.Wearing a corset to straigthen the back and help the traction of the spinal bones

6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles

Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:

1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc

2.laminectomy - traditional surgical removal of the damaged intervertebral disc

Finally treatment of the underlying cause is important

What is the prognosis of Sciatica?
----------------------------------------

Prognosis depends on the underlying cause.

Mild inflammation of the muscles, ligaments may recover with conservative methods

More severe inflammation of the nerve due to disc or spinal may become worse with time.

How do you prevent Sciatica?
---------------------------------

Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight

Sleep on a hard mattress

Wear a corset

Exercises to strenghten the back muscles.

A Simple Guide to Backache

A Simple Guide to Backache
----------------

What is Backache?
-----------------

Backache is a symptom, not an illness.
It is one of the most common complaints.

The complaint may be:
1.Constant aching, pain or stiffness that occurs anywhere along your spine, from the base of the neck to the hips.

2.Sharp pain in the neck, upper back, or lower back, especially after lifting heavy objects or other strenuous activity.

3.Chronic ache in the middle or lower back, especially after sitting or standing for long period of time.

Who suffer from Backache?
--------------------------------

About 80 per cent of people will experience back pain at some point in their lives.
More men suffer from it than women.
Backache is most common among people in their middle age.
Backache also occurs among young people aged between 16 - 24
Backache can also be hereditary (example: ankylosing spondylosis)

What causes Backache?
----------------------------

Acute Backache
Acute backache may occur due to
1.back strain from the lifting of a heavy object,

2.from a fall,

3.violent jerk as a car suddenly stops.

4.fracture of the spine or the dislocation of a vertebral disc

Chronic Backache
Chronic backache may be caused by

1.Osteoarthritis with degeneration of the spinal column when one vertebra slips forward on the one immediately below it

2. slipped disc. The discs act as cushions between two vertebral bones but due to degeneration in old age, or in cases when the spine has been injured before, a slipped disc may occur.

3.Bad posture can also lead to chronic backache such as sitting for long hours in an incorrect position. The right position is to stand up or sit up straight instead of slouching in a couch when watching TV. If the bad posture is prolonged, backache may occur.

4.sprains in the muscles of the back and

5.gynaecological problems (such as ovarian tumours,fibroids) and pregnancy.

6. Chronic infections of spine such as Tuberculosis

7. Cancer of the organs of pelvic region such as bladder or prostate

8. Cancer of the spine from primary bone marrow or secondary spread.

How can Backache be prevented?
--------------------------------------

1.Maintain the correct posture at all times. When standing or sitting, ensure that your back is kept straight instead of a slouched position.

2.support your back and use a cushion when necessary.

3.Correct furniture can also help to prevent the occurrence of backache.
Use chairs of a proper height in relation to the table or desk.

4.Sleep on a firm mattress

5. Do not wear high heels

6. Keep your back straight when carrying heavy item.Keep the item close to the body.

7.Do not bend the back to carry heavy objects. Bend the knees and keep the back straight

8.Exercise is another good way to prevent backache by strengthening the back muscles. However, if you have had back injuries before such as a slipped disc, do be cautious when you exercise.

What to do when Backache occurs?
-----------------------------------------

1. maintain good posture and rest the back.

2.Ice packs can provide relief for backaches. Ice packs will help to reduce the swelling and inflammation.

3.Heat treatment will help improve circulation and reduce stiffness.

4.Painkiller like paracetamol may relieve pain

If pain persists, do consult a doctor.

When should you see a doctor for Backache?
---------------------------------------------------

You should see a doctor under the following conditions:
1. backache is severe and acute.

2.backache starts suddenly and is severe enough to prevent you from work.

3.backache is accompanied with associated pain in legs or weakness and tingling in the legs or back.

4. painkillers and other therapies do not help to relieve pain and your backache is getting worse.

5.pain increases when you cough or bend forward at the waist. This could be a sign of a herniated disk. Try to lie flat with a pillow under your knees.

6.pain follows an injury and is accompanied by sudden loss of bladder or bowel control. If you have difficulty moving any limb, or if you feel numbness, pain, or tingling in a limb, you may have injured your spinal cord.

7.backache is accompanied by nausea, vomiting, fever, muscle weakness, pain down an arm or leg, or bowel or bladder disturbances

8.pain is still present after two to three days of rest.

9.pain lasts longer than 72 hours.

10.pain radiates into the legs,

11.other symptoms such as unexplained weight loss occur,

12.pain is in one side of the small of your back accompanied by a sick feeling and fever. You may have a kidney infection.

13.the pain in your back extends downward along the back of the leg. You may be suffering from sciatica.

14.dull pain in one area of your spine when trying to lie down or getting out of bed, especially if you are over 50 years of age. You may be suffering from osteoarthritis.

15.pain is felt in both thighs when walking. This can be a symptom of spinal stenosis (the narrowing of the lower spinal canal).

16.persistent backache may also be an indication of an undetected cancer of the colon,ovary,bladder or prostate.

How to investigate the cause of Backache?
--------------------------------------------------

1.Full medical history especially of injuries, type of work, onset of pain,radiation to the arms or legs, changes in bowel or bladder habit, loss of weight

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

3. X-ray of the Spine: to exclude fracture, osteoarthritis, dislocation,deformity, bone tumour,

4. X-ray of abdomen to exclude any tumours in the abdomen pressing against the spine

5.MRI of spine for slipped disc,tumours,fracture

6.Bone density test to exclude osteoporosis

7.Blood tests for calcium, protein,kidney function,cancer markers, RA factor

8. Urine and stool tests for blood,

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

What is the Treatment of Backache?
-------------------------------------------

Symptomatic:

Painkillers and muscle relaxants

Ice packs or heat treatment

Physiotherapy to strengthen muscles

Good posture and firm mattress

Avoid aggravating factors like high heels, overstretching muscles,excessive strenous activities

Curative:

The cause must be found and treated. Examples are fractures due to injury.

Causes like cancer and aged related illness(osteoarthritis) may not be cured but may improved with treatment.