What is a slip disc?
A normal disc is made up of an outer tough covering called as annulus fibrosus and an inner soft jelly called as nucleus pulposus. Sometimes discs get injured due to which a fragment of this soft jelly protrudes out through an opening in the outer covering. This is called a slip disc. A slip disc is also called as a disc bulge or prolapsed disc or herniated disc or protruded disc or a disc prolapse.
What is Sciatica?
It is a common misconception that sciatica is caused by a problem of the sciatic nerve. Actually, sciatic pain is caused by a slip disc in the lower back resulting in compression of one of the nerves going into the legs from the back.
What is the reason for slip disc & sciatica?
There is no definite reason as to why someone develops a slip disc. Most patients have a tendency to develop this problem or have a hereditary predisposition to develop this problem. Being overweight and lifting heavy weights are strongly associated with the tendency to develop slip disc. Lack of exercise, extreme bending, long sitting, sudden jerks to the back and smoking can also predispose to this condition.
What are the symptoms of slip disc & sciatica?
This usually results in severe pain, tingling and numbness along the distribution of one nerve in one leg. Some of these patients may also develop weakness of a few muscles in the leg. These patients may develop a compensatory tilting of the spine to one side (LIST) due to muscle spasm. Sometimes, a slip disc can result in an emergency situation called as a cauda equina syndrome.
What is a Cauda Equina Syndrome?
Occasionally, some patients develop numbness in the perianal area along with alteration of control of urine and motion. This is an urgent condition called Cauda Equina Syndrome. These patients need urgent surgery and the sooner this surgery is done, better are their chances of regaining their urine and motion control. If someone has developed symptoms of cauda equina syndrome, they should immediately contact a spine surgeon.
Does a slip disc always need surgery? What is the treatment of slip disc?
The good news is that maximum cases (more than 95%) cases of slip disc do not need any spine surgery. Most cases of slip disc are self-limiting and tend to get better in 3 – 6 weeks even without any specific treatment. A short period of bed rest of 3 days, pain-relieving medications and gradual return to activity is all that is required for the treatment of most cases. Physiotherapy may help in cutting short the recovery time.
What are nerve root blocks or epidural injections?
Transforaminal epidural steroid injections or selective nerve root blocks may be used for pain relief in patients that do not improve within 3-6 weeks. During this procedure, medicine to numb the nerve and to reduce the inflammation is administered right around the nerve under X-ray guidance. Because very small quantities of steroid are used, there are no systemic side effects. This procedure is done in the Operation Theatre but the patient is able to walk out of the hospital within a few hours of the procedure.
How do nerve root blocks work?
The aim in these cases is to give our patients symptomatic relief so that they can tide over the acute phase (as most cases of slip disc are anyways self limiting and will get better with time). Following a nerve block, we advise them to gradually increase their activity levels. Overall, this is an inexpensive and very effective procedure in an appropriately selected patient.
Does slip disc surgery involve an open spine surgery?
No, 99% cases of slip disc that need surgery don’t need an open spine surgery. If surgery is needed for slip disc, it can be done as a microdiscectomy or endoscopic discectomy or keyhole disc surgery. These surgeries involve new technology including the use of microscope, burr, tubes or a spinal endoscope.
Who needs surgery for a slip disc?
This group includes patients who continue to have pain > 6 weeks, patients where nerve blocks have failed, patients with progressive weakness of the legs and patients with severe weakness of leg muscles eg. foot drop or if someone has developed a cauda equina syndrome.
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