Slipped Disc patients can now prevent surgery

Past Admins, 6 years ago

Slipped Disc or Disc Herniation is a term, given to the discs when they usually come out from their original position whenever spine encountered with any form of excessive loading. This loading may occur because of the following reasons:-

• Excessive sitting at one place daily for long hours
• When your job demands frequent bending
• Lifting of weights in awkward positions
• Sedentary lifestyle
• Lack of stability around spine
• Trauma
• Occupational stress
• Postural faults
• Poor warm-up before any exertional activities

In accordance with the report of World Health Organization in 2002, Low Back Pain constituted 37% of all occupational risk factors which occupies the first rank among the disease complications caused by work. Such high prevalence of complications at international levels has made the World Health Organization to name the first decade of the third millennium as the “decade of a campaign against musculoskeletal disorders (as the silent epidemic)” (WHO, 2005).

Structures of Spine:

1. Bones: There are in total 33 spinal bones or vertebrae in our spine, which are aligned in a fashion of one over another. This gives an axial structure to our body. Cervical bones produce movements at the neck while Lumbar bones produce movements at back. There is no or very minimal movement happens in the Thoracic spine as they do have an attachment with ribs, while Sacrum and Coccyx bones are fused. 2. Nerves: There are 31 pairs of nerves arise from the Spinal cord (a bundle of nerves situated in our spine) which supplies to the whole body. Their function is to provide sensations to the body and carries information from the brain to muscles for movement. 3. Soft Tissues: Spine is surrounded by various big and small muscles which gives support, strength, and movements to spine. It provides a protective layer of soft tissues which we called as “CORE”. Inter-Vertebral Discs: There are 23 discs which present in between two vertebrae, their function is to provide a shock absorber effect whenever spine gets into a sudden load. But whenever discs get more pressure than the ideal limit, they expand and start loosening their position, which ultimately leads to Slipped Disc. As the disc moves, its inner, liquid-like nucleus begins to balloon toward the weakest point in its hard outer casing. (https://spinecare.luminhealth.com/conditions/bulging-disc)

Stages of Slipped Disc

1. Disc Bulge: This is the first stage of slip disc where the Nucleus part of the disc (Nucleus Pulposus) starts getting compress and disc begin expanding. Symptoms:

• Pain in the low back or neck.
• Radiation of pain may or may not present.
• Nature of pain would mostly be intermittent and may occur with certain spinal movements.

2. Disc Protrusion: In the second stage, nucleus part of disc starts breaching the inner layers of Annulus Fibrosus, but will still remain intact inside the sac of the Annular layer. Symptoms:

• Moderate to severe pain in the back which may radiate down to one or both legs and hands.
• Radiation of pain will be present.
• Pain may come along with tingling & burning sensations. Numbness may also be the presenting symptom.

3. Disc Extrusion: In the third stage, nucleus part of disc breaches the outermost layer of Annulus Fibrosus and a part of it comes out. This extruded part of the nucleus may move upwards or downwards which will be termed as Herniated Disc. Symptoms:

• Back pain radiating down to legs and hands.
• The pain would be present along with tingling and numbness.
• Alteration in sensation in the affected limb.
• Distal pain (hand or leg pain) would be more than the back pain in extrusion cases.
• Functional Disability would be higher in extrusion.

Disc Sequestration: In the last stage, the nucleus will come completely out of the Annulus Fibrosus and there will be no point of contact between the sequestrated Nucleus and Annular layer. Symptoms:

• Constant pain
• The weakness of muscles in the affected limb.
• Loss of sensations.
• A patient will mostly be bed bound.
• It’s a medical emergency where early medical support is essential.
• Surgery is the only treatment option.

Treatment Options:

Treatment for back pain largely depends upon the duration from which the patient is suffering and how severe the symptoms of the patient are. Surgery may be the only available treatment option in certain case scenarios but definitely not the only treatment option for all slip disc cases. Painkillers: May help in pain but the effect would be temporary for few hours. Definitely not a permanent solution. Nerve Blocks: An extended form of painkiller in which the nerve is being desensitized so that it will not let the nerve feel any sensation. But again, it also lasts up to few months. Surgery: Should be the last option when all other forms of treatments failed. Conservative Management: Only available option for back pain management. Will also lasts long as it solves the root cause of the problem. Red Flags for Conservative Management: Red flags are actually the medical emergencies where conservative management will not going to give any major differences out there, so it requires immediate medical attention. Here are the Red Flag markers:-

• Incontinence of Bladder and Bowel.
• Weakness in limbs which are affected.
• Loss of sensations in affected parts.
• Significant loss of weight in recent time.
• Tinnitus/ Nausea and Vomiting with back pain.
• Pain along with other neurological symptoms like loss of consciousness.
• Pain in night time.
• History of cancers.
• Disc sequestrations.

Good Conservative Management is the key. This includes:

• Development of good muscle control.
• Maintenance of good posture.
• Avoidance of aggravating activities.
• Avoiding sustained positioning, a regular breaking of posture in intervals.
• Maintain good flexibility of musculoskeletal structures.
• Active lifestyle & a habit of regular spine specific exercises.
• Reducing occupational stress. Workplace ergonomic modifications.
• Building up the core muscles.
• Functional Rehabilitation.
• Body weight management.

Thus, a good conservative management can successfully avoid surgery in Slipped Discs with better outcomes.