Lumbar Disc Prolapse

The Normal Disc

A disc is a cushion-like substance acting as a shock absorber in between two spinal bones. It has an inner soft jelly-like material (nucleus) covered by the outer tough rubbery ring (annulus).

The Prolapsed/ Herniated Disc

Herniated disc, a common spinal condition, refers to the displacement of disk material beyond the normal boundary of the disk space. Herniated discs exert pressure on the spinal canal when they bulge into it. It pinches the spinal nerves, causing pain. It is known by different terms such as slip disc, bulging disc, herniated disc, protruding disc, and ruptured disc. If you suspect a herniated disc, consulting with a qualified herniated disc surgeon is essential.

Stages of Disc Prolapse

The earliest stage of disc prolapse usually starts with minor tears in the outer annulus with small protrusions of the inner nucleus through its coverings. There is no bulging or actual herniation or nerve root compression.

The initial stage of disc bulging is where there is a small focal or diffuse bulge without any nerve compression.

In this, the herniation is more prominent. The inner nucleus protrudes through the outer annulus, causing varying degrees of nerve compression.

By this stage, there is a large fragment of the nucleus that has completely breached its covering (annulus), causing severe nerve root compression.

In this stage, the fragment can get disconnected from its main portion and migrate, causing severe nerve root compression.

Risk Factors

Any imbalance between how strong your spine is or what forces it can withstand and what it is subjected to (stress/ strain/ wear and tear) can result in back problems and disc herniation.

Ageing

Often related to gradual wear and tear process that occur as we grow older (35 – 50 years of age).

Gender

Male have roughly doubled the risk of ruptured disc compared with women.

Improper lifting

Using back muscle instead of legs and twisting while lifting might results in disc prolapse.

Overweight

Excess weight gain adds stress on the disk to support additional weight in the lower back

Strenuous and repetitive activities

Majority of jobs are physically demanding requiring continuous and repeated lifting, pulling, bending, or twisting strains your back leads disc prolapse

Cigarette smoking

Nicotine used in cigars restricts blood flow to the disc thereby aggravates the degeneration process and delays healing leading to cracks in disc.

Family history

Having a family history of back or spine disorders can increase your risk of developing degenerative disc disease.

Genetic and Environmental factors

Genetic factors like Congenital Spine Abnormalities and environmental factors such as physical activities and occupation involving prolonged sitting, and poor posture, can cause the risk of disc prolapse.

Causes, Symptoms and Warnings

Causes:

Repetitive strenuous mechanical activities
Sudden violent trauma
Poor posture – at work and during normal routine daily activities
Sedentary lifestyle

Symptoms:

The symptoms of Lumbar disc prolapse are:

Continuous or intermittent back pain
Sciatica or Leg pain
Activity related back pain
Numbness in lower limbs
Weakness in lower limbs
Loss of sensation in leg and foot
Difficulty in gripping the footwear
Bowel and bladder disturbance (urgency, loss on control, straining- Cauda Equina syndrome –seek immediate medical attention)
Muscle spasms

The presence of these symptoms warrants a hospital visit.

The image of a woman holding her lower hand with low back pain.

Tests & Diagnosis

At Spine 360, the best Spine Hospital in Bangalore, our specialists will conduct a physical examination to evaluate your symptoms and your medical history before recommending the most appropriate diagnostic tests like:

MRI is a noninvasive imaging method of choice to justify the presence of anatomic narrowing of the spinal canal or the presence of nerve root impingement.
X-rays to identify any spur growths that may be compressing your spinal nerves or narrowing the spinal canal.
CT scan taken after injecting a contrast dye

Treatment Options

A man explains his back pain to the Doctor.

Self-care - Restricting the activity, ice/heat therapy - Too long bed rest may give you fragile and weak muscles, and rigid joints, which will make it difficult to do activities that could help curtail the pain
Medication - Nonsteroidal anti-inflammatory medications, Analgesic (painkiller), muscle relaxants
Local epidural steroid injection if not relived by medications
Physiotherapy – Strengthening exercises following percutaneous electrical nerve simulation (PENS) and transcutaneous electrical nerve stimulation (TENS) to reduce muscle spasm
No role of traction
Steroids – No long-term benefits, can have drug related complications

Surgical Treatment Options at Spine360

Indications for surgery include

Non-improvement of symptoms after a period of conservative therapy
Recurrent episodes of pain
Weakness of leg with bowel and bladder disturbance

Goal of surgery is to remove a portion of the disc, which has come out of its confines and is pressing on the nerve, called discectomy.

Discectomy is performed in a minimal invasive fashion by endoscopy or tubular assisted approach to minimise the damage to surrounding muscles. Surgery is performed under general anaesthesia with a small incision (around 2 cms ) in the back.

Spine experts perform surgery for a patient with lumbar spine problem.

Transforaminal Endoscopic Lumbar Discectomy (TELD)

Transforaminal Endoscopic Lumbar Discectomy (TELD) is a minimally invasive surgery for lumbar disc prolapse. It involves a small incision and an endoscope to access and remove herniated disc material through the foramen, offering rapid recovery, less postoperative pain, and preservation of spinal stability, with high success rates in symptom relief.

Interlaminar Endoscopic Discectomy

Interlaminar Endoscopic Discectomy is a minimally invasive approach for lumbar disc prolapse, utilizing a small incision and an endoscope inserted between spinal laminae.

Tube-assisted Discectomy

Tube-assisted discectomy for lumbar disc prolapse involves a small incision through which a tubular retractor is inserted, creating a tunnel to the affected disc.

What can I expect after surgery?

Patient are made to walk the same day
Patients who undergo surgery generally do well and experience benefits of early regression of pain and early return to activity.
Typically leg pain is the first symptom to reduce followed by back pain and weakness in leg
There’s a 5 % to 10 % chance of recurrent disc herniation after the surgery

Lifestyle modification, strengthening of back muscle, routine exercises reduces the percentage of recurrence.

Expert Care Assured Relief

Get expert care for lumbar disc prolapse from our experienced surgeons at Spine 360. Book an appointment today!