Prolapsed intervertebral disc

Prolapsed Intervertebral Disc

A prolapsed intervertebral disc, commonly referred to as a "slipped disc," occurs when the soft inner gel of an intervertebral disc bulges out through a tear in the tougher outer layer. This condition can lead to nerve compression, causing pain, numbness, or weakness in the limbs.

Anatomy and Physiology

The human spine is composed of 33 vertebrae, which are separated by intervertebral discs. These discs act as shock absorbers and allow flexibility in the spine. Each disc consists of two parts:

• Nucleus Pulposus: The soft, gel-like center of the disc.
• Annulus Fibrosus: The tough, fibrous outer layer that encases the nucleus pulposus.

The discs are located between the vertebrae from the cervical spine (neck) to the lumbar spine (lower back).

Pathophysiology

A prolapsed disc occurs when the annulus fibrosus is weakened or torn, allowing the nucleus pulposus to protrude. This can compress nearby nerves, leading to symptoms such as:

• Radiculopathy: Pain radiating along the path of a nerve.
• Paresthesia: Tingling or numbness in the affected area.
• Muscle Weakness: Due to nerve compression.

Causes

Several factors can contribute to the development of a prolapsed disc:

• Age-related Degeneration: Discs lose water content and elasticity over time.
• Trauma or Injury: Sudden impact or strain can cause disc herniation.
• Genetic Predisposition: Family history of disc problems.
• Occupational Hazards: Jobs involving heavy lifting or repetitive motions.

Diagnosis

Diagnosis of a prolapsed intervertebral disc typically involves:

• Physical Examination: Assessing reflexes, muscle strength, and sensation.
• Imaging Studies:

 * MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues.
 * CT Scan (Computed Tomography): Useful for visualizing bone structures.
 * X-rays: To rule out other causes of back pain.

Treatment

Treatment options vary depending on the severity of symptoms:

• Conservative Management:

 * Rest and Activity Modification: Avoiding activities that exacerbate symptoms.
 * Physical Therapy: Exercises to strengthen the back and improve flexibility.
 * Medications: NSAIDs for pain relief and inflammation reduction.

• Surgical Intervention:

 * Discectomy: Removal of the herniated portion of the disc.
 * Laminectomy: Removal of part of the vertebra to relieve pressure on the nerve.

Prognosis

The prognosis for individuals with a prolapsed intervertebral disc is generally good, with many patients experiencing significant improvement with conservative treatment. Surgical outcomes are also favorable, particularly when nerve compression is relieved.

Prevention

Preventive measures include:

• Maintaining a Healthy Weight: Reduces stress on the spine.
• Regular Exercise: Strengthens core muscles and improves flexibility.
• Proper Lifting Techniques: Using the legs rather than the back to lift heavy objects.

Also see

• Intervertebral disc degeneration
• Spinal stenosis
• Sciatica
• Laminectomy