Herniated nucleus pulposus (slipped disc; Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disc; Prolapsed intervertebral disc; Ruptured disc)
- What is Herniated nucleus pulposus?
- Statistics on Herniated nucleus pulposus
- Risk Factors for Herniated nucleus pulposus
- Progression of Herniated nucleus pulposus
- How is Herniated nucleus pulposus Diagnosed?
- Prognosis of Herniated nucleus pulposus
- How is Herniated nucleus pulposus Treated?
- Herniated nucleus pulposus References
- Drugs/Products Associated with Herniated nucleus pulposus
What is Herniated nucleus pulposus?
A slipped disc, or herniated nucleus pulposus, is a condition in which part or all of the soft, gelatinous central portion of an intervertebral disk (the nucleus pulposus) is forced through a weakened portion of the disk, resulting in back and leg pain caused by nerve root irritation.
Please click here for a diagram of a Herniated nucleus pulposus.
Statistics on Herniated nucleus pulposus
Disc herniation occurs more frequently in middle aged and older men, especially those involved in strenuous physical activity. Other risk factors include any congenital conditions that affect the size of the lumbar spinal canal.
Risk Factors for Herniated nucleus pulposus
Being of middle age and male are predisposing factors to the condition and, as stated, strenuous physical activity can also bring about the disorder.
Other risk factors include any congenital conditions that affect the size of the lumbar spinal canal. Smoking, increased coughing, prolonged sitting and excessive driving have been associated with increased rates of herniation related to different pressures on the disc.
Progression of Herniated nucleus pulposus
Much has been written concerning the process of spinal deterioration or spondylosis, which occurs over a lifetime. Disc deterioration leads to lack of stiffness and diminished stability resulting in episodic pain. The episodic pain is common and may be temporarily severe.
Optimism remains in the long run, as continued deterioration leads to a restabilisation of the spine. Patients in their 50s and 60s customarily are stiffer but have less pain than younger patients in their 30s and 40s who are undergoing initiation of the degenerative cascade. Patients who ask if they have to live with this pain for the rest of their lives can be reassured from this natural history. Furthermore, spontaneous recovery of an acute episode routinely occurs, so any treatment must be demonstrated effective by positively altering the expectation without treatment.
How is Herniated nucleus pulposus Diagnosed?
A neurological examination will be performed to evaluate muscle reflexes, sensation, and muscle strength. Often, an examination of the spine will reveal a decrease in the spinal curvature in the affected area. Straight-leg-raising test that reveals leg pain is diagnostic of a herniated lumbar disc.
Prognosis of Herniated nucleus pulposus
Most people will improve with conservative treatment. A small percentage may continue to have chronic back pain even after treatment. People who injure themselves on the job tend not to do as well as those without such injuries.
It may take several months to a year or more to resume all activities without pain or strain to the back. Certain occupations that involve heavy lifting or back strain may need modification to avoid recurrent back injury.
How is Herniated nucleus pulposus Treated?
The mainstay of treatment for herniated discs is an initial period of rest with pain and anti-inflammatory medications, followed by physical therapy. Under this regime, over 95% of people will recover and return to their normal activities. A small percentage of people do need to go on and have further treatment which may include steroid injections or surgery.
For people with an acute herniated disc caused by some sort of trauma (like a car accident or lifting a very heavy object) and immediately followed by severe pain in the back and leg, narcotic pain relievers and non-steroidal anti-inflammatory medications (NSAIDs) will be prescribed.
Any extra weight being carried by an individual, especially weight up front in the abdomen, will worsen any back pain syndrome. A program of diet and exercise is crucial to improving back pain in overweight patients. Physical therapy is another crucial treatment for nearly everyone with lumbar disk disease. Therapists will instruct you how to properly lift, dress, walk, and perform other activities.
For the few patients whose symptoms persist despite the above interventions, surgery may be a good option to control pain. A Discectomy is performed to remove a protruding disc under general anesthesia. The hospital stay is short, about 2-3 days. You will be encouraged to walk the first day after surgery to reduce the risk of blood clots.
Complete recovery takes several weeks. If more than one disc needs to be taken out or if there are other problems in the back besides a herniated disc, more extensive surgery may be needed. This may require a much longer recovery period.
Other surgical options include micro discectomy, a procedure removing fragments of nucleated disc through a very small incision with x-ray guidance and chemo nucleosis (injection of an enzyme into the herniated disc to dissolve the protruding gelatinous substance). This procedure may be an alternative to discectomy in certain situations.
Herniated nucleus pulposus References
- Apley A, Solomon L. Apley's System of Orthopaedics and Fractures, 8th Edition. Butterworth Beinemann, 2001.
- Deyo R, Weinstein J. Low Back Pain. NEJM 2001;344;5:363-370.
- Foster M. Herniated Nucleus Pulposus. eMedicine. Web MD, 2005. Accessed [online] from http://www.emedicine.com/orthoped/topic138.htm (4/4/2006).
- Kirkaldy-Willis WH: Managing Low Back Pain. 2nd ed. New York: Churchill Livingston; 1988.
- Kumar and Clark. Clinical Medicine, 5th ed. WB Saunders, Toronto (2002).
- Lancet: Risk factors for back trouble. Lancet 1989 Jun 10; 1(8650): 1305-6.
Drugs/Products Used in the Treatment of This Disease:
|Modified: 27/3/2013||Created: 26/12/2003|
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