What is a Disc Prolapse?
The spinal column consists of bones called vertebral bodies. Between the vertebral bodies lies the disc. These discs are like rubber washers and allow movement of the spinal column. The disc contains nucleus pulposis (jelly-like material) surrounded by a annulus fibrosis (fibrous ring). When the annulus becomes diseased (weakened) due to injury or any other condition then the nucleus pulposis herniates out or prolapses into the spinal canal. This condition is called disc prolapse. The prolapsed disc material may compress on the spinal cord and its accompanying nerve roots.
What are the symptoms?
The prolapsed disc can press on the spinal cord and its nerve roots leading to pain, numbness and or weakness in one or both the legs depending on where the prolapse occurs. If the prolapse is large it can lead to loss of function including weakness of either or both lower limbs and may also affect bowel and urinary bladder control.
How is it diagnosed?
Usually the symptoms of a patient who presents with back and leg pain with associated weakness are enough to help the doctor identify the problem. However, other diseases of the spine like infection, tumour and fracture can also present with similar symptoms. To rule out other conditions, various blood tests, X-rays, CT scan or MRI scans are advised.
MRI is the imaging modality of choice. It is always required before any surgical intervention is performed. (See figure a, b, a large disc prolapse compressing the nerve roots is seen)
Figure a Figure b
What is the treatment?
Almost 90- 95% of patients who get disc prolapse will resolve with medical treatment. This includes rest, analgesics (pain relief) and physiotherapy.
Rest is advised for only 3-4 days after which assisted physiotherapy is required.
If the symptoms do not resolve after 6 weeks of treatment or if any nerve or spinal cord related symptoms increase like numbness, weakness or loss of bowel and bladder control, then immediate surgery may be required.
What are the surgical options available?
The goal of surgery is to decompress (remove the pressure) the nerve root. There are many surgical options available.
- Routine discectomy
- Micro-discectomy (Gold standard)
- Endoscopic discectomy
What is micro-discectomy?
Through a small incision (1 inch) in the midline of the lower back. Under microscope visualization a small opening is made in the bony spinal canal. The prolapsed disc material compressing the nerve is identified and excised. This relieves the pain and allows for nerve function recovery.
Micro discectomy is the preferred mode of surgery in our hospital. The operating theatre is equipped with the latest 'Carl Zeiss’ (Germany) operating microscope.
The advantages of microdiscectomy are:
- No muscle damage or removal of bone or ligaments or damage to facetal joints resulting in post-operative instability
- Small incisions of 2 - 3 cms
- Less pain after Surgery
- Early mobilisation and return to home.
- Early return to work, significantly lesser complication rates and higher safety.
- Less hospital stay, lesser financial burden.
After a micro-discectomy when can I get back to work?
Most patients doing a desk job can get back to their job by the 3rd to 6th week. Patients involved in heavy manual labour can go back to work by 8 to 10 weeks. In all cases rigorous spine rehabilitation exercises are required. Your doctors will advise you on the same.
How can a disc prolapse be prevented?
Regular care of the back with toning up exercises is the most important factor that helps to prevent further episodes of back pain. The other factors are to learn how to avoid inadvertent strains to the back. Techniques for sitting, driving long distances and lifting weights must be learnt. Smoking is harmful and should be stopped.
This information is provided by Ganga hospital and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the hospital (0422-2485000) to book an appointment to see a doctor. This document was last reviewed on: 1/05/2008