Spine or backbone is made up of 33 vertebrae and interconnected with intervertebral discs. These discs act like shock absorbers. Each disc is made up of nucleus and annulus. Nucleus is a soft gel core, which is surrounded by a flexible outer ring called annulus. Spinal nerves pass from the vertebra and exit posterior to the disc. The disc sometimes goes through wear and tear due to aging, rupture, fracture or crack due to sudden jerk, accidental injuries or lifting heavy weights. Due to this the gel inside the disc comes out. It is called a slipped disc or herniated disc. It can occur anywhere along the length of the spine, cervical region, thoracic at the level of upper back or lumber at lower back region. Consult Dr Ravi Rai, best Neurosurgeon at Rachit Hospital, Gorakhpur for expert advice and treatment options for slipped disc.
When a patient complains of shoulder pain, neck pain, pain in the back or leg, the doctor evaluates symptomatic areas for tenderness, checks whether the pain aggravates or gets relieved with any particular movement. Different tests are carried out, based on the concerned area. Upward and downward movements of the neck, crossing your hands to pat your back etc. are small exercises to identify the exact location of the pain. Doctors will perform walking tests and check the strength of muscles.
The straight leg raise (SLR) test is an indicator of a slipped disc in patients under 35 years of age. Doctors ask patients to lie on their back and lift the affected leg. If a patient finds difficulty in bending the knee, and the knee stays straight then it is the sign of a slipped disc. Consult Dr Ravi Rai, the best neurosurgeon at Rachit Hospital, Gorakhpur.
Physicians will evaluate reflexes of fingers and toes to check whether the pain is due to nerve involvement.
After bedside evaluation is done, physicians will start primary care, i.e., medications, physiotherapy, and cervical traction.
For further diagnosis, physicians will advise X-ray, CT scan or MRI to look for skeletal changes.
X-rays are helpful to differentiate herniated discs from other infections of neck and back, tumours, or fractures.
Multiple X-rays are taken with different angles to produce a cross-sectional image of the spine to diagnose a slipped disc.
Slipped disc causes nerve compression. Magnetic Resonance Imaging is effective in locating the nerve which is compressed.
It is a special diagnostic technique to examine the spinal canal. A contrast dye is injected into spinal fluid before taking X-rays. It detects the abnormalities of the spinal cord, nerves, and other surrounding tissues.
Electromyograms (EMG) and nerve conduction studies can give useful ideas about nerve signals. Consult Dr Ravi Rai, the best neurosurgeon at Rachit Hospital, Gorakhpur.
Non-surgical management: Initially in slipped disc cases, doctors focus on relieving the pain. It includes rest, pain medications, physiotherapy, yoga, and exercise.Rest:
Doctors will advise bed rest for 2-3 days. Patients are not allowed to walk to avoid pressure. Patients should not bend forward and lift heavyweights. Patients should avoid sitting for longer hours. Take breaks if working on a laptop.Physiotherapy:
Physiotherapy is beneficial in reducing pain. Stretching exercises will open the movement of the neck and strengthen the muscles around the neck. Physiotherapists will guide patients for home exercise positions. Massage is also effective in pain-relieving.Pain Medication:
Non-steroidal anti-inflammatory drugs like Ibuprofen, Naproxen, Acetaminophen (Tylenol) are effective in relieving pain, muscle spasms, as well as improving sleep disturbance. Local application of ointment gives short term relief. Application of hot bags and taking hot baths is beneficial. Cold packs reduce the pain due to irritated nerves.Epidural Injections:
Sometimes pain reliever injections are given into muscles and nerves around the spinal canal with the help of spinal imaging. Corticosteroid injections along with pain reliever injections have been found effective in pain of neurological origin.
Injections have some side effects such as radiography exposure, bleeding, infection, nerve damage, muscle weakness, etc.
Most of the time pain goes off in six weeks, in cases of slipped discs the body gets adapted to it in six weeks if pain persists more than that it requires surgery.Surgical Approach:
When non-surgical treatment is ineffective, surgery is considered to treat slipped disk.
It involves the surgical removal of abnormal disc material of the intervertebral disc or the whole disc that compresses the nerve or spinal cord. If the whole disc is removed, vertebrae are allowed to heal by fusion to form as a single bone.
Artificial disk replacement:
To treat lower back pain, artificial disk replacement is used. After spinal fusion, the flexibility of the spine is limited. Artificial disk replacements aid in providing mobility to the spine. In this surgery, the disc of concern is replaced with an artificial disk implant.