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| Patient Education -- Slipped Disc |
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Slipped Disc
What adult has not complained of an aching back at one
time or another? How many people have experienced the
sudden pain of "throwing one's back out?"
In most instances, back pain is simply the result of unusual
exertion, fatigue or a twist or sharp movement, but in
some cases, there has been an injury to the spine and
medical attention is required. One of the most common
injuries to the spine is a slipped, or herniated, disc.
This condition can be extremely painful, and may damage
surrounding muscle and nerve systems. If pain is very
severe, if it persists or worsens when you lie down, if
it travels down your leg or if numbness sets in, then
a physician must be consulted.
What is a disc?
A disc is a small mass of elastic, gristle-like tissue.
Located between each vertebra in the spinal column, discs
act as shock absorbers for the spinal bones. Thick ligaments
attached to the vertebrae hold the pulpy disc material
in place.
What is a slipped disc?
When some of the disc material pops out of place and bulges
into the spinal canal, this is also known as a herniated
or ruptured disc.
Why do disks herniate?
Occassionally, a single excessive strain may cause a slipped
disc. However, disc material degenerates naturally as
we age, and the ligaments that hold it in place begin
to weaken. As this degeneration progresses, a relatively
minor strain or twisting movement can cause a disc to
pop out of place.
Certain individuals may be more vulnerable to disc problems,
and as a consequence may suffer herniations at several
places along the spine. Research has shown that a predisposition
for slipped discs may exist in families, with several
members affected.
What are the symptoms of a slipped disc?
Extreme, sudden pain is usually the first symptom. Since
most herniations involve the bottom two discs in the spinal
column, the pain usually begins in the lower back. The
bulging disc in this location exerts pressure on the sciatic
nerve, and sharp pain may follow that nerve all the way
down the leg and into the foot. Pressure on this nerve
may eventually cause numbvness or a "pins and needles"
sensation. Over time, the surrounding muscles can weaken
and shrink in size.
Discs can also rupture at higher levels in the spine causing
pain and weakness in the neck, shoulders and arms.
Even if the initial pain subsides, it is important that
the condition be diagnosed and treated in order to prevent
further damage.
How is a slipped disc diagnosed?
A number of tests are used to make a precise diagnosis
and to pinpoint the site of the herniation, such as x-rays,
myelography, computed tomography (CT) scans, and magnetic
resonance imaging (MRI).
What is the treatment for a slipped disc?
The first goal of treatment is to relieve pain by decreasing
the muscle spasm. Physicians may presecribe pain relievers,
muscle relaxants and bed rest. As the muscle spasm subsides,
the pressure in the nerve root at the disc protrusion
eases.
When the herniation is higher on the spinal column, special
collars or eventraction may relieve the pressure.
Most slipped discs respond well to this kind of treatment,
and a carefully designed exercise program to strengthn
the surrounding muscles can be very helpful in preventing
future ruptures.
In some cases, however, the pain is severe and intractable;
there may even be nerve damage. In theseinstances, a neurological
surgeon may have to remove the disc material. When the
disc is removed, the pressure on the nerve is released,
and this may rapidly relieve pain and permit restoration
of lost muscle function.
Role of the Neurosurgeon
Neurological surgery is the medical specialty concerned
with the diagnosis and treatment of disorders affecting
the nervous system, the brain or the spinal cord. Neurosurgeons
may treat injuries to the head, spinal cord or nerves;
strokes (or patients in danger of a stroke due to clogged
arteries in the neck); brain or spinal cord tumors or
malformations; or the back and neck pain associated with
a slipped disc. Depending on the nature of the surgery
or illness, neurosurgeons may provide surgical or non-surgical
treatment. Neurological surgeons undergo six to eight
years of rigorous training following medical school. After
completeing this training, two years of practice and an
examination, neurological surgeons can become Board Certified.
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