Prof. Dr Ambarish Mathesul | Best Spine Specialist Pune

What is slip disc or herniated disc?

Disc herniation means the cushion that sits between the spinal bones (vertebra) is pushed outside its normal position. Since the spinal nerves are in close proximity to these discs, thus the herniation of disc produces problems along with the nerve distribution i.e; electric-like shock or pain goes down along the leg (in lumbar slip disc patients) or arm (in cervical slip disc patients).

When the spinal cord or spinal nerves become compressed due to slip disc, they don’t work properly. This means that abnormal signals may get passed from the compressed nerves (eg: pain, tingling), or signals may not get passed at all (eg: numbness/weakness/paralysis). Common symptoms of a herniated disc include:

 

Electric shock pain

Pressure on the nerves can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shock goes to your arms. But when compression occurs in the lumbar (low back) region, the shock goes to your legs (also known as sciatica).

 

Tingling & Numbness

This type of abnormal sensations is commonly experienced with a slip disc. These pins and needles sensations occur in the arms (in cervical slip disc patients) and legs (in lumbar slip disc patients). Similarly, some patients complain of numbness in the same area.

 

Muscle weakness

We already know – our brain orders commands and body follow those orders. Signal for anybody action (eg: foot movement or hand movements) starts in the brain goes down to the spinal cord then goes to the spinal nerves and then to arms or legs. In severe form of slip disc, nerve pinch is also significantly more and thus brain signals are interrupted much more leading to muscles weakness. In other words, the brain wants to move the foot (or the hand) but is unable to do so. In simple words, it is a poor transmission of current something like a state of paralysis.

 

Bowel or Bladder problems

It is very important as it may be a feature of cauda equine syndrome. It is a medical emergency as it should be urgently managed if you have difficulty in passing urine or stool (constipation) or numbness around the genitalia due to slip or herniated disc

What causes the slip disc?

In young individuals, the soft disc can slip (herniate) due to lifting heavyweight, excessive traveling, excessive bending work or sometimes there may not be any associated factor. In elderly patients disc become hard due to natural aging and due to disc dehydration and thus already has some tendency to bulge but the above precipitating factors can further contribute to the disc herniation. One common point seen in almost all patients is that they have weak back (spinal) muscles and they are unaware of back strengthening exercises. Smoking is also a contributing factor.

How is the diagnosis of a herniated or slip disc made?

The diagnosis of slip disc is made by 3 things:- patient’s history (complains), an examination by a spine specialist and finally an appropriate MRI of the problematic area.

The diagnosis of lumbar disc herniation requires history where the patient complains of low back pain which goes down the leg and that too the backside of the leg i.e.; from hip to the back of thigh and leg/foot (this is classical sciatica pain). While with cervical disc herniation, a patient complains of neck pain which also goes to the arm and hands.

Next, a thorough examination by a spine specialist is done by checking sensations, muscle strength, reflexes, etc. With this much information an experienced specialist doctor can most of the times tell what is likely the cause and where is the slip disc i.e.; whether it is in cervical / dorsal/ lumbar area.

Next, he advises you to undergo MRI investigation for confirmation of the diagnosis, which is again a simple test like any scan and thus does not require any prick or anesthesia. These 3 things (complaints, examination, MRI) when “put together” give surely the further plan of action. This “put together” is actually the most important aspect which decides the correct plan in case of a herniated disc, and it comes with only experience and many years of dedicated practice of the specialist doctor.

What is treatment of herniated or slip disc?

♦ Symptoms experienced by the patient

♦ Age of the patient

♦ The activity level of the patient

♦ Presence of worsening symptoms

Treatment of a herniated disc mostly begins with:

♦ Rest & activity modification

♦ Physical therapy

♦ Medicines: pain killers

♦ Surgery ( if it becomes necessary).

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