Dr. Jayesh Pawar

Patients who are overweight and who have poor lifestyle (wrong posture, long sitting, inactivity) are more prone to develop these degenerative changes.

Patients who are overweight and who have poor lifestyle (wrong posture, long sitting, inactivity) are more prone to develop these degenerative changes.

depending upon size herniated disc, duration of pressure on nerves and inflammation around the nerve. Initially, patients will feel pain at the site of disc prolapse (neck in case of cervical disc prolapse, upper back in case of thoracic disc prolapse and lower back in lumbar disc prolapse).

When spinal nerves in the vicinity starts getting affected, pain and tingling-numbness in the extremities (radiculopathy or Sciatica) which may lead to loss of sensation or loss of muscle power in severe cases. In extreme situation with sudden and severe pressure on spinal cord, patient might lose bladder-bowel control also, which requires urgent spinal cord decompression surgery to prevent permanent damage to the spinal cord. A disc prolapse in cervical and thoracic spine can also cause rigidity in the body (spasticity) with loss of balance.

spine specialist may also find evidence of nerve stretch and compression signs on upper/ lower extremity in the form of loss of sensation and muscle weakness. An X-RAY is usually done as first line of investigation to rule out major bone abnormality.

In severe cases which are not responding to medical treatment and physiotherapy, an MRI Scan is done which will show the level and degree of prolapsed disc, and will help spine specialist determine which kind of treatment will be best for the patient. In certain situations an EMG-NCV (Electromyography-Nerve Conduction Velocity) is done to assess nerve function. A CT Scan is done when detailed assessment of bone structure is required or when MRI cannot be done.

to help them live an active life. For the patients who don’t get relief by medical treatment, various options are available.

• Epidural Injections: For patients who primarily present with radiculopathy (arm/ leg pain) and don’t have emergency symptoms (loss of sensation, weakness, loss of bladder-bowel control), epidural injection can be tried to provide pain relief to the patient. A small amount of anaesthetic medication and steroid are injected next to the prolapsed disc. This reduces inflammation on spinal nerve as well as disc material to provide relief to the patient. If symptoms recur, injection can be repeated 2-3 times.
• Microdiscectomy: Patients who do not get adequate relief after medical treatment or epidural injection, or those who have emergency symptoms need to undergo slip disc surgery with removal of protruded disc material. Microdiscectomy is most commonly done slip disc surgery. A small hole is made on the skin and only the part of disc which has come out is removed. There is immediate relief of symptoms and recovery is very quick.
• Endoscopic Discectomy: A small tube like endoscope is inserted in the body under local/ general anaesthesia and protruded disc is removed under magnified endoscopic vision. Recovery from this surgery is very quick and this procedure can be done as day-care also.

In patients with associated significant back pain/ neck pain, severe disc degeneration (spondylosis), vertebral slip (spondylolisthesis), spine fracture (spondylolysis) and spine deformity (scoliosis/ kyphosis), a spine fusion/ instrumentation might also be advised by your spine doctor along with the removal of slipped disc.