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Slipped Disc

  • What is a slipped disc?

    Slipped disc

    A disc is sandwiched between 2 vertebrae (individual bones) in our spine. These discs have a soft, jellylike centre (nucleus pulposus) that also act as shock absorbers.

    A slipped disc occurs when the gel covering (annulus) of a disc in the spine tears (herniates) and shifts, causing the gel to press on the nerve root. This condition is also known as a herniated, ruptured or prolapsed disc.

    Changes to the discs that happen with age may also cause the discs to dehydrate, and result in the stiffening of their cartilage. When these changes happen, the outer layer of the disc may bulge out around its circumference. This condition is known as a bulging disc.

  • The main cause of a slipped disc is gradual wear and tear as the discs lose their elasticity and become more prone to damage or rupture with even a minor strain or twist. Other causes include:

    • Injury from lifting heavy objects incorrectly. The use of the back muscles instead of the leg and thigh muscles to lift heavy objects can lead to a slipped disc.
    • Traumatic events. In rare occasions, a fall or a blow to the back can result in a slipped disc.

    Risk factors for a slipped disc

    The following factors can increase the risk of a slipped disc:

    • Ageing. This can also cause the degeneration of disc elasticity, and results in the disc becoming more prone to injury. Any injury that adds pressure on the spine may cause a slipped disc.
    • Genetics. People with a family history of slipped discs are likely have a genetic predisposition for the conditions.
    • Poor posture. Incorrect exercising or sitting for long periods, especially with a poor posture, may cause a slipped disc.
    • Weight. Increased body weight causes extra stress on the discs in your lower back.
    • Occupation. Jobs which are strenuous and physically demanding increase the risk of causing a slipped disc.
    • Smoking. Nicotine and other toxins from cigarettes and tobacco products prevent absorption of nutrients by the discs, which in turn accelerates disc degeneration and contribute to further disc damage.

    Preventing a slipped disc

    There are several steps you can take to help prevent a slipped disc:

    • Exercise. Exercises that strengthen the trunk muscles are helpful to stabilise and support the spine.
    • Good posture. Practising good posture reduces pressure on the spine and discs. When sitting, keep your back straight and aligned. Heavy objects should be lifted by bending your hips and knees and not by bending forward.
    • Healthy weight. Maintaining a healthy weight reduces pressure on the spine and discs.
    • Quit smoking. Discs stay hydrated and pliable longer without the toxins from cigarettes depriving them from vital nutrients.
  • Slipped disc symptoms can be felt in the neck, back and limbs, depending on where the affected disc is, and whether the disc is pressing on a nerve. They include:

    • Numbness or pain that starts from the lower back and shoots down the buttock or legs (sciatica)
    • Pain in buttocks, thigh, calf, and part of the foot
    • Sharp or burning pain in shoulder and arm that may shoot to the arm or leg when coughing, sneezing or moving into certain positions
    • Numbness or tingling that radiates from the body part served by the affected nerves
    • Weakness in muscles that cause stumbling, or affects the ability to lift or hold items
    • Difficulty controlling bowel movements and urination
    • Numbness in the genitals and anus

    Differentiating between a muscle strain and a slipped disc can sometimes be hard. Discomfort from a backache or muscle strain usually goes away within 6 weeks, while pain caused by a slipped disc may progressively worsen. A herniated disc also usually causes more pain compared to a bulging disc.

  • A slipped disc diagnosis usually only requires a physical examination and a review of your medical history. Your doctor will check your back for tenderness and may perform a neurological exam to check your reflexes, muscle strength, walking ability, and ability to feel light touches, pinpricks or vibrations.

    To confirm or exclude the diagnosis of a slipped disc or to determine which nerves are affected, your doctor may sometimes order one or more of the following tests:

    • MRI

      Magnetic resonance imaging (MRI) is currently the gold standard for diagnosing slipped discs. It is used to confirm the location of a slipped disc and to see which nerves are affected
    • CT scan

      A computed tomography (CT) scan is done by taking a series of X-ray images and combining them to create cross-sectional images of the spinal column and surrounding structures
    • X-rays

      Regular X-rays can rule out other causes of back pain, such as an infection, tumour, spinal alignment issues or a broken bone
    • Nerve conduction study

      The study measures electrical impulses in your nerve signals when a small current passes through the nerve
    • Electromyography

      The test evaluates the electrical activity of your muscles when they contract and when they are at rest
  • The treatment of a slipped disc is dependant on how severe the condition is. For mild cases, attending physiotherapy and rehabilitation programmes for a few weeks to minimise the risk of future disc injury, as well as taking pain killers, muscle relaxants, and keeping the body active, may be sufficient.

    Surgery is typically recommended after more conservative treatments have been exhausted, or if there is evidence of pressure on the spinal cord that may lead to further health complications such as incontinence.

    Treatment of a slipped disc includes:

    • Home remedies. Cold packs can help to reduce inflammation and heat after 2 or 3 days. Alternating warm and cold packs may provide some relief from sciatica pain.
    • Medications. Over-the-counter pain medications and non-steroidal anti-inflammatory drugs (NSAIDs) may relieve mild to moderate pain. If your pain does not improve with oral medications, your doctor might recommend cortisone injections or muscle relaxants to help in managing muscle spasms.
    • Physical therapy. Physiotherapy and rehabilitation involve stretching and exercises to reduce pain and sciatica, and to minimise the risk of recurring injuries. A variety of active treatments are available that help address flexibility, posture, strength, core stability, and joint movement.
    • Surgery. This is typically recommended only if nonsurgical treatment has not relieved painful symptoms, or if patients experience more serious symptoms. Discectomy to remove a portion of the herniated disc will alleviate pressure on the nerve, and the goal of the procedure is to relieve pain and improve leg and back strength.

    Consult an orthopaedic surgeon to determine the treatment method most suitable for you.

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  • In some people, disc herniation can compress the entire spinal canal. This includes a group of long nerve roots that are located just below the spinal cord. This condition, known as cauda equina syndrome, may result in several complications, such as:

    • Worsening symptoms

      Increased pain, numbness, or weakness that can affect your daily routine
    • Incontinence

      Bladder or bowel dysfunction may result in incontinence or difficulty urinating even with a full bladder
    • Saddle anaesthesia

      Progressive loss of sensation that affects the areas that would touch a saddle (ie. the inner thighs, back of legs, and area around the rectum)
    • Permanent weakness or paralysis

      A delay in diagnosis and treatment may lead to permanent never damage affecting the bladder, bowel, and legs
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