Sciatica/ Slipped Disc

What is a slipped disc?

Injury or weakness can cause the inner jelly like portion of the disc to protrude through the outer ring. This is known as a slipped or herniated disc. This causes pain and discomfort. If the slipped disc compresses one of your spinal nerves, you may also experience tingling, numbness and pain along the affected nerve. As the lumbar spine (lower back) carries most of the body weight, it tends to slip more than higher levels.

What is the anatomy of disc herniation / herniated disc / slip disc / sciatica?

Human Spine is made of up 33 bones (vertebrae) that are cushioned by discs. These vertebrae are divided by region: neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). At the lower end of your spine, you also have the sacrum and the coccyx, which is commonly called your tailbone. Discs are present between these bones. The disks protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting. Each disc has two parts a soft, gelatinous inner portion (nucleus pulpous) and a tough outer ring (annulus fibrosus) . Together, the vertebrae and discs form a tunnel through which the spinal cords and nerve pass.

What are the causes of slip disc?

The etiology/cause of slip disc is multifactorial; there is no evidence to prove/disprove the quantitative effect of one or other. The risk factors for slip disc can be:

Life style: Stress and emotional tension, poor posture -standing for long periods of time or sitting incorrectly can cause slip disc , heavy physical work, lifting or forceful movement, bending, or awkward positions can really hurt your back.
Obesity: Being overweight puts pressure and stress on the back, especially the low back. Carrying excess weight aggravates other health conditions such as osteoporosis (weak bones), osteoarthritis (joint pain), rheumatoid arthritis (an autoimmune disease), degenerative disc disease (described above in the aging section), spinal stenosis, and spondylolisthesis.

What are the symptoms of Herniated disc OR Slip disc ?

Symptoms of a slipped disc include:

Sciatica Pain in buttock radiating to leg
pain and numbness, most commonly on one side of the body
pain that extends to your arms and/or legs
pain that worsens at night
pain that worsens after standing or sitting
pain when walking short distances
unexplained muscle weakness
tingling, aching, or burning sensations in the affected area
sciatica— a sharp shooting pain that can extend from the buttock into the leg and sometimes into the foot.
muscle spasm, locked back , stiffness in back , morning stiffness.
Although rare, herniated discs can cause you to lose bowel or bladder control known as Cauda Equine Syndrome and one should seek medical advice as prognosis deteriorates with time. one can know whether this is happening to him or not if he has urgency /frequency of urination or loss of control of urination or sudden peri anal anesthesia

When do i need to have a spine doctor opinion ?

Patients with progressive symptoms in leg / back need a specialist opinion to diagnose and treat the problem.

Symptoms which need specialist attention (RED FLAGS)are:

Persistent leg pain
Numbness in leg
Weakness in leg
Difficulty in walking
Unable to control urine / motion

Symptoms like bowel and bladder urinary incontinence shall seek urgent / emergency opinion /management by the spine specialist.

Which tests will be needed to confirm the diagnosis?

Imaging studies / investigations help to arrive a diagnosis of slip disc / herniated disc and include :

X-rays
MRI scans
Disco grams, which are rarely utilized

What are the treatment options for slip disc ?

There are different options to treat slip disc depending on the severity and duration of symptoms. They may comprise of one or many :

Drugs & Medications
Spinal Injections
Spine surgery

Drugs, Medications, to Relieve Slip disc :
Medication alone is not the ultimate solution to your back pain, however during emergency or during severe pain these medicines may help you curb the suffering.

Paracetamol :
Your doctor may call this an analgesic, they don't help reduce inflammation, though.

NSAIDs (non-steroidal anti-inflammatory drugs) :
These will help reduce swelling (or inflammation) while relieving your pain; that's how NSAIDs differ from paracetamol.

Muscle Relaxants :
Which will help stop the muscular spasms.

Anti-depressants :
As surprising as it may seem, anti-depressants can be effective drugs for treating pain because they block pain messages on their way to the brain. They can also help increase your body's production of endorphins, a natural pain killer.

Opioids :
In the most extreme cases, and only under careful supervision, you doctor may also prescribe an opioid.

Medication Warning :
As with all medications, you must follow your doctor's advice precisely.

Spinal Injections :

(A) Injection techniques

Root Block Injection
Epidural Injection
Caudal Block Injection
Facet Block Injection

The options of surgery are

Decompression
Spinal Fusion

The spine surgery advised for Slip disc can be performed in many different ways. The success rates of surgery in slip disc/ herniated disc / sciatica is 98 % and with invention of modern technology and minimal invasive surgery techniques it nears 100 %. Spine surgery can be performed in different manners :-

Conventional Open surgery
Minimal Invasive Spine surgery – Key hole spine surgery
Endoscopic Spine Surgery
Microscopic spine surgery
Micro endoscopic spine surgery

Decompression includes

Facetectomy : A procedure that removes a part of the facet (a bony structure in the spinal canal) to increase the space.
Foraminotomy : A procedure that removes the bony compression over foramina (the area where the nerve roots exit the spine) to increase the size of the nerve pathway.
Laminoplasty : A procedure makes more room for the spinal canal.
Laminotomy : A procedure that removes only a small portion of the lamina (a part of the vertebra) to relieve pressure on the nerve roots.
Micro-discectomy : A procedure that removes a disc through a very small incision using a microscope.
Laminectomy : A procedure for treating spinal stenosis by relieving pressure on the spinal cord.
Spinal Fusion : surgery intends to stabilize an unstable segment responsible for pain, this may involve putting some screws in your spine to increase stability.

Various options of doing spinal fusion are PLF /PLIF/TLIF/ ALIF/XLIF

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