Slip Disc

What is the intervertebral disc? 

The lumbar disc consists of an outer tough structure called annulus fibrosus and a centrally placed jelly like material called nucleus pulposus. Posterior to the disc are neural structures that are responsible for power and sensations in the lower limbs along with control of bladder and bowel functions.

What is a disc herniation or slipped disc? 

The lumbar disc starts degenerating form the early 20s and progresses based on the genetic predisposition of the individual. This degeneration is universal and is part of the ageing process. Lumbar disc herniation is the failure of the tensile annulus (tough outer covering of the disc) to contain the central nucleus pulposus (central jelly like disc material). This usually occurs due to weakening of the annulus as part of degeneration process.

What are the symptoms of a disc herniation? 

Patients suffering from this problem usually have sudden onset of low back pain and one sided (or bilateral) leg pain. This leg pain most commonly radiates from the buttocks to the back and side of thigh to the back and side of leg and the dorsum of the foot. This leg pain may vary in distribution based on the nerve that is affected. The leg pain is due to affection of the nerve root due to pressure by a herniated disc. The neural compression may also lead to weakness and abnormal sensations (pins and needles) in the legs.

What is the best investigation for evaluating a Disc herniation? 

If you are suffering from any of the above symptoms, get yourself checked by a spine specialist. If your specialist feels that further investigations are required, he/she may suggest an MRI scan. This is the best radiological investigation to confirm the diagnosis.

What are the types of lumbar disc herniations? 

Lumbar disc herniations are classified by various means based on the site (central, lateral recess, foraminal, extra foraminal) and degree of herniation (protrusion, extrusion, sequestration).

What is the treatment for Lumbar disc herniation? 

A wide variety of treatment options are available for treating lumbar disc herniations. Always consult your spine surgeon before starting your treatment. Majority of patients respond well to physiotherapy, back exercises, rest, analgesics etc. Surgery may be required in patients who have neurological deficit or those who do not respond to other treatment. The Gold standard in surgical management is Micro-Lumbar Discectomy.

What is Micro-Lumbar Discectomy? 

This is a microscopic technique of decompressing the nerve root by excising the offending herniated disc (picture 7). This relieves the radicular pain (buttock and leg pain) almost instantaneously. When done via minimally invasive techniques, patients are allowed to walk (mobilized) in a few hours after surgery.

What are the restrictions after Micro-Lumbar Discectomy? 

After undergoing microscopic discectomy patients are asked to avoid lifting weights, forward bending and jerks to the back for a few weeks. Patients are encouraged to walk after surgery.

What are the complications of Micro-Lumbar Discectomy Surgery? 

The two complications, which need to be avoided, are infection and damage to nerve root. The chances of these are about 1%. Appropriate care is taken to avoid these complications by operating in well-equipped surgical set ups, use of microscope etc.