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Mechanism and treatment of herniated disc (lumbar disc prolapse)

Saturday, 18 December 2010



Herniated disc can be the cause of intolerable back pain. Let's first clearly summarize the basic anatomy of the vertebral column. The vertebral column is made up of vertebrae (bones) that are separated by intervertebral discs. Here is a normal spine:


A normal intervertebral disc is shown below (seen from above).
The disc consists of a central soft area known as nucleus pulposus and a tough outer ring known as annulus fibrosus. Factors as trauma and degeneration may cause a tear in the annulus fibrosus which will lead to herniation of the nucleus pulposus outwards. This is simply the mechanism of a herniated (slipped) disc. 
The herniated disc will start to compress the nearby nerves causing back pain which is accompanied with a sharp lancinating leg pain (known as sciatica and femoralgia). The mechanism is illustrated in this image:

The following video clearly illustrates the mechanism of a herniated disc:
http://www.youtube.com/watch?v=putDjJ9k1u0



What is the treatment of a herniated disc ?

There are two options: medical treatment and a surgical one. In 90% of the cases, the medical treatment relieves the symptoms. 
Medical treatment measures include:
  • Avoid painful positions. 
  • Apply local heat to the area of pain.
  • Medications as analgesics can help relief the pain. 
  • Physiotherapy, vitamin B supplements, muscle relaxants and weight reduction can contribute to the success of the medical treatment.
Surgical treatment is done in these cases:
  • Failure of the medical treatment to relief symptoms.
  • Progressive motor weakness.
  • Cauda equina syndrome.
Surgical discectomy is the procedure done. 

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