Do I have a prolapsed disc?

Backaches can surprise you when you least expect them. One second you’re lying down comfortably on your bed watching T.V, and the next you try to get up, and “OUCH.”

A pain radiates around your lower back and maybe down the leg.

The question arises, “Could you have a slipped disc?” Chances are you might!

Generally, an adult’s spine is made up of 24 vertebrae. Most of them are cushioned by jelly-like discs. They allow you to move your spine around and also bend over. 

But if one of these discs, between the two vertebrae, starts slipping out, it can compress the surrounding nerves and cause utmost pain. This condition is what we call a slipped, herniated, or ruptured disc.

Aging plays a major role in its cause. The best way to tell if you really do have a slipped disc is to consult the doctor.

Is surgery necessary for disc prolapse in the lumbar spine?

A significant number of people who are diagnosed with a disc prolapse in the lumbar spine will get better with non-surgical treatment.

Initial pain control for a Lumbar Herniated Disc includes Ice application, Pain medications, Muscle relaxants, Heat therapy, etc.

Physiotherapy is important for the rehabilitation process. This may also educate the patient to use alternate safe methods for daily life activities.

An epidural steroid injection can also offer pain relief in some cases. The effects may vary and the pain relief is sometimes temporary.

Spinal manipulation can also be performed by an experienced Chiropractor/Osteopath to provide a good healing environment.

When surgery is deemed urgent?

When there is a large disc herniation causing compression of the nerve root. These lumbar nerve roots send information to and from the bladder, bowel, and legs. If they remain compressed for too long, the damage caused may be irreversible hence surgery becomes an emergency..

This is called Cauda Equina Syndrome, and is a rather extreme consequence of Lumbar Disc Herniation.

The common surgical methods are:

Open microdiscectomy: 

It uses surgery to extract and remove part of the damaged disc and thus helps to mitigate the pressure on the nerve tissue and alleviate the pain. It is done by a small incision in the skin over the spine.

Endoscopic discectomy:

It uses the least-invasive procedure performed that includes the removal of the herniated disc material. This is done to ensure a speedy recovery and to prevent the emergence of any scars. An endoscope is inserted through a small incision and pushed through to the spinal disc affected.

The treatment options are tailored to each individual patient and are based upon a good understanding of evidence-based practice.

Percutaneous nucleotomy:

This is done through even smaller incisions and could be done under very light anesthesia to manage bulging discs causing nerve compression without a prolapse.

Evidence-based information

By this we mean, the type of treatment is thoroughly analyzed and the best procedures are chosen based on the best evidence-based research published in the literature to get the best results.

In other words, the treatment is tailor-made.

Let us take Lumbar spine fusion as an example. A patient who needs relief from nerve compression or has spinal instability or both may require Lumbar Spine Fusion. A person with just back pain may not get relief, in the long term, via this procedure.

Fusion surgery can also be done for the neck and also for scoliosis.

RLDH

Recurrence of lumbar Disc Herniation is plausible, but the prevalence is low. RLDH is the occurrence of herniated disc material at the same level and side in a patient who has undergone surgery.

The patients who are highly susceptible to recurrent herniation are young patients with a lot of residual disc height and who are likely to be more physically active. Operative interventions for RLDH are appropriate for those patients with neurological deficits or symptoms resistant to conservative measures. The two major procedures are Revision Lumbar Discectomy and instrumented fusion. A second opinion may be very valuable in making this type of decision.

What should you do if you experience immense lower back pain?

There are numerous home remedies for acute back pain, which a doctor can advise you on, or you can simply refer judiciously to the internet!

If the pain remains, or if it turns chronic, you are better at getting an opinion from the doctor, ideally a Spine surgeon. 

The doctor will perform neurological exams to check your muscle strength, reflexes, walking ability and ability to touch toes, etc. If the doctor suspects something, will order various imaging tests like an X-ray or MRI scan. There are various nerve tests like NCS & EMG, that can measure how well electric impulses are moving along nerve tissues.

Treatment is done evidence-based, individually for each patent. Normally non-surgical procedures may do. But if surgery is recommended, do not worry, since the procedures used are minimally invasive and safe.

Trust your doctors to make the best judgment!

Where can I get an expert medical opinion?

eSehati is the first app-based second medical opinion platform in UAE. 

Our expert spine surgeon Dr. Michael, Antony Louis Rex is one of the best doctors in UAE to help you to get an opinion regarding your health conditions. 

Once you sign up, your details and investigations can be uploaded through the app for doctor’s reference. 

An expert medical opinion is just an app away!