Disc Prolapse and Its Management

Intervertebral disc disease is as old as humanity itself. Skeletal remains from all periods, from the era of early humans to modern times, show evidence of damage to the vertebral column and discs due to wear and tear. This high prevalence of these conditions reflects today’s longer life expectancy and often affects relatively younger people. Hippocrates (460-377 BC) first described sciatica as “hip pain” and treated it by cauterization with a hot poker.

Disc-related complaints, particularly low back pain, are very common, and almost all of us will suffer from them at some point in our lives. The point prevalence of back pain is 35%, meaning 35% of individuals will report experiencing back pain on the day they are questioned. The lumbar region is affected in 62% of cases, the cervical spine in 36%, and a few cases of thoracic disc prolapse (2%) also exist.

At Hannah Joseph Hospital, we understand the impact that disc prolapse can have on your quality of life. Our dedicated team of specialists is here to provide comprehensive care and personalized treatment plans to help you manage and overcome this condition.

Symptoms and Pain Mechanisms

Local and radiating pain due to intervertebral disc disease are generated by irritation of different components of the nervous system. The pain may be ‘referred,’ meaning it is felt in the distribution of an irritated segmental nerve, such as sciatica. Local pain, on the other hand, is felt at the site of the causative problem, like the prolapsed disc in the cervical and lumbar regions (neck and back).

Conservative Treatment (Medical)

At Hannah Joseph Hospital, we prioritize conservative or medical management for patients presenting with back pain without any radiation of pain to the limbs. Our approach includes:

– Bed Rest and Activity Modification: Encouraging patients to rest and modify activities that may exacerbate the pain.

– Physiotherapy: Tailored exercises to strengthen the back and improve flexibility.

– Analgesics (Painkillers): Non-steroidal anti-inflammatory drugs (NSAIDs) or opioids (for severe pain) can provide symptomatic relief. These can be administered orally or via parenteral routes.

– Muscle Relaxants: These can offer additional benefits for some patients.

– Epidural Corticosteroid Injections: These may provide short-term pain relief for acute pain syndromes.

– Avoiding Traction: We do not recommend traction, as bed rest can be achieved without the discomfort of weights pulling over the neck or low back.

Surgical Treatment

Emergency or urgent surgical intervention is required when patients present with symptoms such as urinary retention, numbness over the limbs, progressive or profound motor weakness affecting the limbs (Cauda Equina Syndrome). In these situations, patients should not wait to try medical management, as neurological deficits can become irreversible with delayed treatment.

Indications for Surgical Intervention:

  1. Acute Onset Severe Shooting Pain: Pain over the upper or lower limbs due to a large herniated disc prolapse that does not respond to medications.
  2. Prolonged Sub-Acute Pain Syndrome: Pain disrupting normal work patterns for more than 4 to 8 weeks despite conservative treatment.
  3. MRI Diagnosis: MRI of the spine is the gold standard for diagnosing disc prolapse. Based on MRI findings, patients are offered medical or surgical treatment.

Surgical Options

There are various surgical options for treating disc prolapse:

  1. Laminectomy and Discectomy: The conventional method.
  2. Microdiscectomy: A minimally invasive technique.
  3. Endoscopic Methods: Minimally invasive procedures using endoscopy.

The choice of surgical method is determined by:

– Clinical presentation and neurological deficits.

– Age of the patient and the nature of their work.

– Co-morbid or associated illnesses.

– MRI findings, including co-existing canal stenosis (narrowing) or ‘listhesis’ (movement of adjacent vertebral bodies).

– Some patients may require spine fusion with implants if they have multilevel disc disease or co-existing spondylolisthesis.

It is important not to be swayed by fancy names and newer terminologies of surgical procedures. Each patient requires a surgical procedure based on the specific clinical and radiological findings, not by the surgeon’s or the patient’s preference. The ultimate aim of any surgical treatment is to achieve good relief of symptoms with minimal or no complications and no recurrence of the illness.

Comprehensive Care at Hannah Joseph Hospital

At Hannah Joseph Hospital, we take pride in providing top-notch care for patients suffering from disc prolapse. Our multidisciplinary team ensures that every patient receives a personalized treatment plan tailored to their specific needs and medical condition.

Trust Hannah Joseph Hospital for Expert Care

Disc prolapse can significantly impact your quality of life, but with the right care and treatment, you can manage and overcome this condition. At Hannah Joseph Hospital, we offer a comprehensive approach to managing disc prolapse, from conservative treatments to advanced surgical options. Our goal is to provide the best possible outcomes for our patients, ensuring their well-being and swift recovery.

If you or a loved one is experiencing symptoms of disc prolapse, don’t hesitate to contact Hannah Joseph Hospital. Our team of experts is here to support you on your journey to recovery, providing the highest standard of care with compassion and expertise.

Author:

Dr. M. J. Arunkumar M. Ch., D.N.B.
Senior Consultant Neurosurgeon
Hannah Joseph Hospital,
Madurai.