Prolapsed Disc

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Prolapsed discs is the condition of a vertebral disc pushing outside of its designated space, which typically puts pressure on nearby nerves. Vertebroplasty

A prolapsed disc, also known as herniated or bulging discs, can be caused from back trauma, or regular back strain from heavy lifting. Researchers report some 5% of lower back pain is due to prolapsed discs. While a small percentage, this condition is one of the leading causes for back surgery.

When a disc is prolapsed, the inner liquid layer of the spine presses against the outer thick tissue layer causing a bulge. This bulge presses on a spinal nerve root, causing pain, numbness or weakness. The most common prolapsed discs are found in the lumbar, or lower, spine. They can also occur in the neck. When a disc is prolapsed in the lumber spine, it can cause radiating nerve pain; the pain is actually felt in another area of the body, typically the lower extremities or groin. This can also cause bowel and bladder incontinence, however this is most likely seen in patients with a more advanced form of prolapsed disc called Cauda Equina.

To assist with diagnosis, an X-ray should be ordered to search for possible fractures which could be a cause of the pain.  A CT or MRI scan can be ordered to produce images of the inter-vertebral discs to look for possible nerve root compression.  Finally, a nerve conduction study could also be ordered.

Initial treatment for low back pain is physical therapy, in addition other treatments options are:

  • Lifestyle changes, including weight loss, a healthy diet and regular exercise
  • Over-the-counter non-steroidal anti-inflammatory medications (NSAIDS) for management of pain
  • Opioid medications or muscle relaxants for more severe pain
  • Epidural steroid injections

For the 10% of patients who do not respond to these conservative treatment options, surgery may be required to alleviate pressure on the nerve root and ease pain. The most common surgeries are open discectomy, micro-discectomy and endoscopic.

To prevent prolapsed discs, patients should practice good posture and use proper lifting techniques to avoid injuries and strains to the lower back.

References

  • Prolapsed Disc – PainDoctor.com
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  • Fardon, D.; Milette, P. (2001). Nomenclature and Classification of Lumbar Disc Pathology: Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. Vol 26, E93-E113.
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  • Gibson, J. N. A.; Waddell, G. (2007). Surgical Interventions for Lumbar Disc Prolapse. Spine. Vol 32 1735-1747.
  • Chou, R. and Huffman, L.H. (2007). Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. Vol 147(7), 492-504.