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Prolapsed Disc (Slipped Disc)

While the terminology is misleading, a disc does not actually slip. In reality, a part of the inner gel-like part of the disc between two vertebrae begins to bulge outwards through a weak spot in the outer part of the disc.

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The prolapsed part of the disc can potentially put pressure on a nerve nearby and, as a result, one of the disc prolapse symptoms is a sudden onset of acute lower back pain.

A prolapsed disc is sometimes also referred to as a herniated disc. The bulging disc may occasionally put pressure on other nerves or nearby structures. Some inflammation is also likely to develop around the prolapsed portion of the disc. In addition, inflammation may lead to irritated nerves and also bring about some swelling, which may, as a result, put pressure on a nerve.

Most often, a slipped disc condition happens in the lower lumbar spine. The pain may extend down a leg. The size and severity of the prolapse could vary from person to person. As a general rule, the larger the prolapse, the more severe the symptoms are likely to be.

Who can get a slipped disc?

Most cases of prolapsed discs occur in people between 30 and 50 years of age. Statistically, two times as many men are affected by this condition as women. This condition is rare in anyone below 20 years of age. Less than 1 among 20 cases of sudden and acute back pain are due to a prolapsed disc.

Causes

It is speculated that some people may have a weakness in the outer part of the affected disc making them more prone to this condition. Different factors may trigger the inner softer gel-like part of the disc to squeeze out through the weakened outer harder component of the disc:

• Sneezing
• Awkward bending
• Heavy lifting in an awkward position, may cause extra pressure on the gel-like portion to push itself outwardly
• A job that involves a lot of lifting
• A job that involves lots of driving or sitting upright
• Sports like weightlifting, etc
• Smoking
• Obesity
• Old age

Disc Prolapse Symptoms

Back pain

One of the disc prolapse symptoms is back pain. The pain is often acute and usually comes on suddenly and progresses quickly. The pain is worse if you move your back too much, sneeze or cough.

Nerve root pain (usually sciatica)

When a nerve coming out from the spinal cord – or the root of the nerve – is irritated, inflamed or pressed upon you may experience nerve root pain or sciatica. Sometimes it is also called a trapped nerve and occurs in less than 1 out of every 20 people who complain of acute low back pain.

• There is pain along the length of the nerve.
• Typically pain extends down a leg, sometimes as far as the calf or the foot.
• Pain in the lower back is often not as bad as the pain down the leg or foot.
• You may experience pins and needles, weakness or numbness in part of a buttock, leg or foot.
• Depending on which nerve is affected, weakness could appear in different parts of the body

Cauda equina syndrome – rare, but an emergency

Cauda equina syndrome is a very rare disorder where the nerves at the very bottom of the spinal cord are pressed upon. This disorder can cause:

• Lower back pain
• Problems relating to bowel
• Problems relating to bladder function (usually being unable to urinate),
• Numbness in the saddle area (the groin, buttocks, and upper thighs) around the anus
• Weakness in either or both legs

This syndrome must be treated as an emergency and requires urgent medical treatment so that the bladder and bowel do not become permanently damaged.

Therefore, it is important to note that some people do not have disc prolapse symptoms as prolapsed discs can sometimes be dormant and asymptomatic. This condition does not require medical intervention as long as the prolapse does not put pressure on any nerve. Some prolapses may be small, cause minor insignificant or no symptoms or occur away from the nerves.

How does a slipped disc progress?

• In many cases, the symptoms tend to reduce over a few weeks.
• Studies of repeated MRI scans have revealed that the bulging prolapsed portion of the disc tends to shrink or regress as time progresses.
• In many cases, the symptoms may go away completely.
• About 50 out of every 100 people improve within 10 days of the onset of pain, and almost 75 out of 100 people report marked improvement after four weeks.
• Only a very small number of people, about 2 out of every 100 people with a ‘slipped’ disc are still in severe pain even after 12 weeks may need surgery.

Do I need any tests?

Tests such as X-rays or scans may be necessary if symptoms seem to continue over a long period of time. More specifically, an MRI scan can reveal the precise site and size of a prolapsed disc. If considering surgery as treatment, this information is crucial.

Your doctor should be able to diagnose a ‘slipped’ disc from any disc prolapse symptoms you may present upon physical examination. It is the most common cause of sudden back pain with nerve root pain symptoms

Treatment

Staying active

• Try to continue with normal activities as far as possible. This may not be possible in the beginning if the pain is very bad.
• Move around within the home at least, as soon as you are able to.
• Don’t do anything that causes or increases existing pain.

Sleep

• Remember to sleep in the most comfortable position on whatever surface is the most comfortable, it does not matter if it is hard or soft.
• Some people reported that a small firm pillow tucked between the knees when sleeping on the side helps relieve pain.

Exercise

• Some exercises designed by physiotherapists to work on at home may aid a speedy recovery.
• They may help strengthen lower back muscles in the long run and reduce the chances of recurrence or severity of the pain when it does come again.
• Taking complete bed rest is not the best way to go about managing back pain.

Medication

• Anti-inflammatory painkillers include ibuprofen, diclofenac or naproxen which may require a prescription from a doctor.
• Some people may not be able to take anti-inflammatory drugs. For example, those who suffer from asthma, high blood pressure, kidney failure, or heart failure.
• If anti-inflammatories do not work well, codeine could be considered as an option. This may be consumed as co-codamol, which is codeine with paracetamol and acts as a stronger pain killer. Constipation is a common side-effect of codeine. Therefore this may aggravate back pain if you need to strain to go to the toilet. To circumvent this problem, be sure to have lots of fluids and drink water and eat foods that are rich in fiber.
• Prescription of a muscle relaxer such as diazepam is rare and usually only for a few days if the back muscles become very tense making the pain unbearable. Diazepam can be habit-forming as it provides quick and significant relief from pain and therefore should be taken for a very short period.
• Antidepressants or medicines for neuropathic pain, such as amitriptyline, duloxetine, gabapentin or pregabalin,  may rarely be prescribed if the pain has not subsided or reduced for a long period of time.
• If you decide to take painkillers, it is best to take them regularly. This is better than taking them only when the pain is extremely bad. Taking them regularly ensures that the pain is more likely to be relieved for longer periods of time. This allows you to exercise better and keep more active.

Physical treatments

Some people may choose to seek the services of a chiropractor or osteopath for manipulation and/or other physical treatments. While it is still unclear if they provide relief in the long term, they may provide some short-term comfort. It is always recommended that they are accompanied by regular exercise.

Epidural

An epidural is an injection in the back around the area where the sciatic nerve comes out of the spine. Only a specialist can administer an epidural. The injection contains a special combination of local anesthetic and steroids, which is a very strong anti-inflammatory concoction. It is essentially a long-term painkiller that can give you enough pain relief that you can start or continue to exercise and go back to your normal routine activities more quickly.

Surgery

Surgery may be considered an option in some rare cases if the symptoms are very severe and the pain is excruciating, or the symptoms have not reduced even after medical intervention over six weeks or so. The surgery aims to cut out the prolapsed part of the disc and release the pressure on the nerves. This often reduces symptoms. Recent studies reveal that while surgery may be a better option in the short term, it makes no difference in the long term. The effects of the surgery seem to wear off after the first few months.

Can further incidents be prevented?

Research suggests that the best way to prevent future spells of low back pain is simply to be as active as possible and to exercise regularly.

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