ANATOMY OF DISC
- Nucleus pulposus is the jelly like mass bounded by the annulus. It is rich in proteoglycans and is responsible in maintaining the water content of the disc
- Annulus Fibrosus is the lamellar layer bounding the nucleus pulposus and is rich in collagen fibres.
STAGES OF PROGRESSION - DISC PROLOAPSE/ HERNIATION
Bulging disc
Extension of disc tissue beyond the the margins of the ring apophyses, throughout the circumference is described as bulging.
- Diffuse bulging is produced by small tears in the annulus fibrosis.
- Asymmetric bulging is produced by a 25% or greater portion of the disc adapting to the adjacent deformity.
Disc bulge should not be confused with disc herniation as the annular covering is still intact in a disc bulge unlike a herniation.
Disc Herniation
Focal displacement of the disc material < 25% of the disc circumference , beyond the confines of the intervertebral disc space represents a disc herniation.
Contained herniated discs have an outer covering of annulus fibres and the posterior longitudinal ligament whereas Uncontained herniated discs lack the annulus covering. Contained herniations present with smooth margins on the protrusions.
Disc Protrusion and Extrusion
It is described as Protrusion when the distance between the edges of the disc herniation is lesser than the distance between the edges of the base.
Disc Extrusion is said to be present when the distance between the edges of the disc material is greater than the distance at the base.
Extrusion is almost always associated with a defect in the annulus fibrosus and is usually noncontained.
Disc Migration
Migration indicates displacement of disc material away from the site of extrusion, regardless of whether it has broken down into fragments.
Disc Sequestration
The term sequestration signifies that the displaced disc material has lost continuity with the parent disc.
Intravertebral Disc herniation
Intravertebral herniation or Schmorl node is herniation of disc material in the vertical direction through a gap in the vertebral end plate.
CONSERVATIVE MANAGEMENT is usually the first line of treatment that is undertaken in most of the cases
- Physical therapy, exercise and gentle stretching to help relieve pressure on the nerve root
- Ice and heat therapy for pain relief
- Manipulation (such as chiropractic manipulation)
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or COX-2 inhibitors for pain relief
- Narcotic pain medications for pain relief
- Oral steroids to decrease inflammation for pain relief
- Traction and spinal decompression machines have been tried but have been advised against as per recent literature.
IMAGE GUIDED INTERVENTIONS are reserved for cases not responding favourably to conservative treatment. Disc bulge, protrusion and relatively smaller herniations should be definitely given a trial of image guided interventions.
- TRANSFORAMINAL INJECTIONS
- INTERLAMINAR EPIDURAL INJECTIONS
- CAUDAL EPIDURAL INJECTION
- OZONE NUCLEOLYSIS
- PLATELET RICH PLASMA
- STEM CELLS
AT ALLEVIATE, we follow a multidisciplinary approach involving which includes Comprehensive Platelet Rich Plasma with Prolotherapy to the lower back following Image guided Anti Inflammatory injections for pain and symptom control.
This is coupled with a structured back strengthening program, lifestyle modifications and inputs from Clinical Nutrition and Clinical Psychology.
Surgeries such as Microdiscectomy and Endoscopic Discectomy are
- usually reserved for patients not responding to Non Operative means.
- Patients exhibiting motor weakness
- Migrated, Extruded and Sequestered discs causing symptoms often need surgical intervention.
Disc Prolapse & Slipped Disc: Symptoms, Causes & Treatment
A disc prolapse, commonly referred to as a slipped or herniated disc, occurs when the soft inner core of a spinal disc protrudes through its tougher outer layer. This condition can compress nearby nerves, leading to pain, numbness, or weakness in the limbs. Understanding the symptoms, causes, and treatment options is crucial for effective management.
Treatment Approaches for Disc Prolapse
Conservative Management
Initial treatment for disc prolapse often involves non-invasive methods aimed at relieving pain and improving function:
- Rest and Activity Modification: Limiting activities that exacerbate symptoms while maintaining gentle movements to prevent stiffness.
- Physical Therapy: Tailored exercises to strengthen the back muscles, improve flexibility, and reduce pressure on the affected disc.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants to alleviate pain and inflammation.
Image-Guided Interventions
For patients not responding to conservative treatments, image-guided interventions offer targeted relief:
Types of Image-Guided Interventions
- Epidural Steroid Injections (ESIs): Corticosteroids are injected into the epidural space to reduce inflammation around the affected nerve.
- Transforaminal Injections: Medication is delivered directly to the nerve root exit, providing precise pain relief.
- Caudal and Lumbar Injections: These injections target the lower spine to alleviate pain and inflammation.
These procedures are performed under imaging guidance to ensure accuracy and effectiveness.
Alleviate’s Multidisciplinary Approach
Alleviate Pain Clinic adopts a comprehensive, non-surgical approach to disc prolapse management:
- Expert Team: Specialists in pain management, physiotherapy, and rehabilitation collaborate to create individualized treatment plans.
- Advanced Therapies: Utilization of cutting-edge, minimally invasive procedures to address pain at its source.
- Patient Education: Empowering patients with knowledge and strategies to manage their condition effectively.
Surgical Interventions
Surgery is considered when non-surgical treatments fail to provide relief or if there is significant nerve compression:
Common Surgical Procedures
- Discectomy: Removal of the herniated portion of the disc to relieve nerve pressure.
- Laminectomy: Removal of part of the vertebral bone (lamina) to enlarge the spinal canal and reduce nerve compression.
- Spinal Fusion: Joining two or more vertebrae to stabilize the spine.
These procedures are typically reserved for severe cases where conservative and interventional treatments have not been effective.
How to Prevent Disc Prolapse / Slipped Discs?
Preventative measures can significantly reduce the risk of developing a disc prolapse:
Maintain Proper Posture
Ensure correct alignment when sitting, standing, and lifting to minimize spinal stress.
Exercise Regularly for a Stronger Back
Engage in exercises that strengthen core and back muscles, enhancing spinal support.
Avoid Heavy Lifting and Strain
Use proper techniques when lifting objects, and avoid sudden, strenuous movements.
Stay Active and Avoid Prolonged Inactivity
Regular movement prevents stiffness and maintains spinal flexibility.
Maintain a Healthy Weight
Excess weight increases pressure on the spine; maintaining a healthy weight reduces this risk.
Use Ergonomic Support for Spine Health
Utilize chairs and workstations designed to support proper spinal alignment.
Stretch and Strengthen Your Muscles
Incorporate stretching routines to maintain flexibility and muscle balance.
Stay Hydrated for Disc Health
Adequate hydration helps maintain the elasticity and integrity of spinal discs.
Quit Smoking to Reduce Disc Degeneration
Smoking impairs blood flow to spinal discs, accelerating degeneration.
Seek Medical Advice for Early Intervention
Early consultation with healthcare professionals can prevent progression and complications.
Yes, a prolapsed disc is commonly referred to as a slipped disc. It occurs when the soft inner portion of a spinal disc pushes through a weakened or torn outer layer, potentially compressing nearby nerves and causing pain, numbness, or weakness in the limbs.
Pain from a prolapsed disc can last from a few weeks to several months, depending on severity and treatment. Conservative treatments often relieve symptoms within 6–12 weeks. Persistent or worsening pain may require advanced interventions such as image-guided therapies or, in rare cases, surgery.
The fastest way to relieve a slipped disc includes rest, physiotherapy, and anti-inflammatory medications. Image-guided injections offer targeted pain relief when conservative methods fail. At Alleviate Pain Clinic, a multidisciplinary approach ensures efficient non-surgical treatment for quicker recovery and long-term relief.
Symptoms of spinal disc issues include sharp or radiating back pain, numbness, tingling in the limbs, muscle weakness, and limited mobility. Severe cases may cause sciatica or pain that worsens with sitting, bending, or lifting. Early diagnosis and management are key to avoiding complications.
A slipped disc is diagnosed through a combination of clinical evaluation, physical examination, and imaging tests like MRI or CT scans. These tools help identify the location and extent of disc herniation, as well as any nerve compression, guiding appropriate treatment planning.
