Prolapsed Disc

The Spinal Column

The spinal column is formed of 33 individual vertebrae which form a protective casing around the spinal cord. The spinal cord and brain form the Central Nervous System (CNS), this is responsible for receiving and transmitting messages to the rest of the body. Nerve roots from the CNS exit the spinal cord, to form part of the peripheral nervous system (PNS).

Between each vertebra there is an intervertebral disc – these are circular pads of connective tissue composed of a tough fibrous outer layer (the annulus fibrosis) with a soft gel like centre, (the nucleus pulposus). The function of the discs is to prevent the vertebrae from grinding against one another and to absorb the impact of any jolts or bumps during everyday activities.

What Is the Difference Between A Prolapsed Disc and A Herniated Disc?

A prolapsed or herniated disc refers to the displacement of disc material beyond the intervertebral disc space. Both conditions can provoke similar symptoms, however a prolapsed disc occurs when the nucleus of the spinal disc bulges or prolapses outwards but remains contained within the annulus fibrosis.

A herniated disc, occurs when the disc material actually leaks out of the disc through a crack or tear.

If a portion of disc actually breaks off, this is referred to as a segmented fragment. This usually occurs when a portion of nucleus pulposes extrudes through the annular fibrosis and then fragments, subsequently migrating into the spinal canal.

There are a number of terms used interchangeably to refer to disc related issues these include, slipped disc, bulging disc, herniated disc, protruding disc or a prolapsed disc.

Where Are Prolapsed Discs Most Likely to Occur?

A prolapsed disc can occur at any point along the spinal column but is most common in the lumbar spine – this region supports the weight of the upper body and is therefore more susceptible to the wear and tear effects of the ageing process. The cervical spine (neck) is also prone to degenerative conditions due to the greater range of motion of the neck, whereas the thoracic spine is least likely to suffer from disc related issues as it is the most stable region of the spine.

Symptoms of A Prolapsed Disc

disc protrusion

Painful symptoms occur when the prolapsed or herniated disc presses on nearby soft tissue structure such as nerve roots exiting the spinal cord. The irritation or compression of any nerve root causes painful symptoms felt locally or in some cases, radiating to other areas of the body depending on the location and function of the nerve affected. Compression of the sciatic nerve in the lumbar spine for example, may cause painful symptoms felt through the buttocks and legs, sometimes as far as the feet. However, some individuals may be completely unaware of the fact that they have a prolapsed disc as it does not always cause painful symptoms.

The Cervical Spine / Neck

  • Lack of normal range of movement
  • Pain felt in the neck
  • Neck pain during movement
  • Shoulder pain
  • Numbness, tingling sensations in the arms and hands
  • Weakness in certain muscles

The Thoracic Spine

  • Pain felt in the thoracic region which may radiate to the chest area
  • Pain may be exacerbated when coughing or sneezing
  • Symptoms such as pain, numbness and tingling may be referred to other areas of the body including the legs
  • Muscle weakness may be present in the legs

The Lumbar Spine

  • If the prolapsed discs irritates or compresses the sciatic nerve, it can cause Sciatica
  • Pain in the lower back ranging from mild to severe sharp lancinating pains
  • Pain in the legs and buttocks
  • Numbness
  • Pin and needles
  • Tingling sensations

Cauda Equina

Although rare, Cauda Equina is a medical emergency requiring immediate treatment to avoid permanent damage. It occurs when a bundle of nerves exiting the spinal cord in the lumbar spine become suddenly compressed. Symptoms include:

  • Numbness of buttocks and genitalia
  • Loss of control of bladder and/or bowels
  • Lower back pain
  • Paralysis of one or both of the legs

Possible Causes of Prolapsed Disc

Degenerative Changes

As we age our bodies change, bones begin to lose density and soft tissues such as muscle, tendons, ligaments and intervertebral discs lose condition as their moisture content and elasticity become depleted – this leaves the discs more prone to damage and herniation.

Repetitive Strain Disorder

Repetitive movements such as lifting heavy objects, whether it’s at work or when exercising, can cause damage to the intervertebral discs. Poor posture can also contribute towards disc related problems especially when sitting for long periods of time, long distance driving on a regular basis, or office jobs, all of which are often associated with disc related complaints.

Trauma or Injury

Severe impact from a fall or a car accident for example, may cause damage to the spinal vertebrae and discs.

Obesity

Being excessively overweight can put a considerable strain on the body.

Smoking

The effects of nicotine and other toxins found in cigarettes can prevent the discs from getting sufficient oxygen and nutrients, causing the disc tissue to weaken.

Diagnosis

A detailed medical history and description of symptoms will be necessary, during the physical examination the physician may test posture, reflexes, sensations on arms and legs, muscle strength and range of movement. In the case of a suspected prolapsed disc further imagery testing such as an MRI or CT scan may be needed to support the diagnosis.

Treatment

In the majority of cases a prolapsed disc will repair itself within two to three months, therefore conservative treatment methods are usually recommended to help manage painful symptoms – this typically consists of a combination of treatment methods such as pain relief medication, physiotherapy and bed rest if required.

Pain Medication

There are a number of possible medications used to help relieve the painful symptoms of nerve compression caused by a prolapsed disc including the following:

  • over the counter analgesics and NSAIDs
  • prescription only painkiller such as opioids
  • tricyclic antidepressants
  • anticonvulsants
  • spinal injection of corticosteroid and anaesthetic

Physiotherapy

A well-trained physiotherapist can provide highly beneficial treatment, helping the individual to restore movement and function as well as improving strength and posture.

Lifestyle Changes

If the cause of the prolapsed disc was a result of a particular lifestyle choice or habit, the patient may need to adapt their lifestyle accordingly to avoid further disc related problems.

Surgery

In some cases, surgery may be an option if all other conservative treatment methods have failed.

  • Disc fusion surgery
  • Microdiscectomy to remove protruding disc material
  • Prosthetic intervertebral disc replacement may be used in some cases, such as in the treatment of degenerative disc disease
  • Conventional open surgery

Surgery however, carries with it a number of associated risks and cannot guarantee a successful outcome.

Pain Management

The pain management clinic consists of a multi-disciplinary team of health professionals all of whom specialise in chronic pain related conditions. The team typically includes a pain management consultant working with physiotherapists, psychologists, surgeons and other health professionals to provide optimum treatment tailored to suit differing patient needs, by combining the use of pain medication, physiotherapy, psychological support and surgery to treat and manage chronic pain conditions as well as supporting patients in coping with chronic pain and making necessary lifestyle adaptations.

Prevention

Healthy living can help to prevent disc related issues. Regular exercise is beneficial for overall health as well as helping the back remain strong and supple. When lifting any heavy objects using correct technique is extremely important. Good posture whether standing or sitting is extremely important and long periods of continuous sitting should be avoided.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment