SLIP DISC AND ITS TREATMENT

A slipped disc is a common problem that brings patients to the doctor. The patient has pain in the back that travels to the buttock and to the leg on one side. Walking is painful,  and often, the body is bent to one side. Lying  in bed reduces the pain. 

What is the problem? What is the treatment of this painful condition? 

Pressure on the spinal cord and the nerves therein causes the problem. Treatment is medical or may be surgical. Each case is unique and the saying that ‘one size does not fit all’ is true. 

A visit to the doctor confirms that it is indeed a slipped disc. Bed rest, physiotherapy, and painkiller medication are helpful. The pain subsides, and a few days later, the patient is out of bed and reasonably free of pain. This is the story of a simple attack that subsides with treatment and does not require MRI scans or blood tests. 

But what happens if the pain does not resolve, or recurs after a few days? Or if a foot or the toes become weak and cannot be brought up, what is called a foot drop. An MRI scan and blood tests are required. Is the problem due to a slipped disc, problems like a spinal tumor, an infection, or some issue that is pressing on the nerves? In extreme cases, the bowel and bladder can be involved leading to retention or leaking of urine, along with lower limb paralysis. Treatment is likely to be surgical to remove the pressure on the spinal cord. 

There are advocates of injection treatment, whereby injections are given into the spinal cord or around the involved nerve. These contain powerful steroids that calm the nerves but do not reduce the pressure on them. They may be effective in reducing the pain, but how long their effect will last cannot be clearly defined. The pressure is not removed. 

Surgery for the slip disc means removal of the part that is pressing on the nerve and is responsible for the pain Note that it is only the offending part that is removed and not the entire disc There are two techniques to achieve this, and both are minimally invasive techniques the first is microdiscectomy, wherein the surgeon enters the spine through a small incision and using magnification, removes the offending part of the disc The second is endoscopy, where the disc is removed through a small incision using specialized equipment Both techniques, are effective and in both the patient can be discharged home the next day. The technique that is used depends on what works best for the patient. There is a lot of negativity about spine surgery it is performed globally and is a safe procedure The days when patients needed months in bed after spine surgery are long past and patients who have realistic expectations are generally happy with the outcome.