Multi-Level Disc Herniati...

MULTI LEVEL DISC HERNIATION AND PROLAPSE

Spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine.

When the outer fibres of the intervertebral disc is injured, a soft material known as the nucleus pulposus, ruptures out of its enclosed space.  The bulging disc may press on nearby structures such as nerves coming from the spinal cord.

Some inflammation also develops around the prolapsed part of the disc. Inflammation may irritate a nerve and also causes swelling, which may put pressure on a nerve.

Any disc in the spine can prolapse. However, most prolapsed discs occur in the lower back (the lumbar spine).

WHO SUFFERS SPINAL DISC HERNIATION

It is very common to have bouts of back pain. However in most cases of sudden onset, back pains are due to a 'slipped' (prolapsed) disc. The most common age to develop a prolapsed disc is between 30 and 50 years. Twice as many men as women are affected. This condition is rare in people under age 20.

CAUSES

It is not clear why 'slipped' (prolapsed) disc does not occur across board even when they do the same job or lift the same sort of objects. It may seem that some people may have weaknesses in the affected disc that others may not have.

Various things like sneezing, awkward bending, or heavy lifting in an awkward position may cause some extra pressure on the disc. This may trigger the inner softer part of the disc to squeeze out through the weakened outer part of the disc.

Factors that may increase the risk of developing a prolapsed disc may include:

• A job that involves lots of lifting.
• Being obese.
• Weight bearing sporting activity (e.g. weightlifting).
• A job that involves lots of sitting (e.g. driving or office work).
• Lack of physical exercises for lumbar part.

SYMPTOMS

• Back pain

Often severe, this usually comes on suddenly. The pain could be eased by lying still. However, this is often made worse with sudden movement of the back, a cough or sneeze.

• Nerve root pain

This is one that occurs because a nerve from the spinal cord is pressed by a slipped or (prolapsed) disc, or that nerve is irritated by the inflammation caused by the prolapsed disc.

The problem may be in the back, however the pain may be felt anywhere along the course of the nerve in addition to the back pain. The pain may therefore be felt below the knee even as far as the foot. Nerve root pain ranges from mild to severe but it is often worse than back pain.

With a prolapsed disc, the commonly affected is the sciatic nerve. The sciatic nerve comes out from the spinal cord in the lower back. It is a large nerve that is made up from several smaller nerves that travels deep inside the buttock and down the back of the leg. There is a sciatic nerve for each leg.

(Other nerve root symptoms)

• Cauda Equina Syndrome

A particularly serious type of nerve root problem. This can be caused by a prolapsed disc. In this condition, the nerves at the very bottom of the spinal cord are pressed. This syndrome can cause pain in the lower back as well as:

1. Problems with bowel and bladder (especially the inability to pass urine).
2. Weakness in one or both legs.
3. Low back pain and erectile dysfunction.
4. Numbness in the saddle area around the anal region.

Cauda Equina syndrome will usually need urgent treatment to stop the nerves that connects the bladder and bowel from becoming permanently damaged.

• Some People Are Asymptomatic

Studies and research done on a large number of people have revealed that some people have prolapsed disc with no symptoms. The general thinking is that symptoms may occur if the prolapse exerts pressure on, or irritates a nerve.

Somehow, in some cases, prolapses may occur away from the nerves or be small and thus will cause either minor or no symptoms.

TREATMENTS

• Keep living normally: As much as possible live normally. This will be difficult especially if the pain is very bad. However, moving around as much as possible and getting into normal activities could help overcome the symptom a great deal. You will have to accept some level of discomfort in trying to be active, but this is actually useful.

One is likely to recover more quickly and will be less likely to develop chronic back pain if he remains active instead of resting with back pain. It is also advisable to sleep in the most naturally comfortable position, and on the most comfortable surface.

• Physical treatments: Some people visit a chiropractor or osteopath for manipulation and/or other physical treatments. It is debatable whether such physical treatments help all people with a prolapsed disc but they may provide some short-term comfort. They should be accompanied by regular exercise.
• Medication: If painkillers are recommended, it is best to take them regularly. This is better than taking them only when the pain is very bad. Taking them regularly is more likely to ease the pain for much of the time, which will enable continued activity.

1. Anti-inflammatory painkillers. These may include diclofenac and ibuprofen, which are easily sourced over the counter. It is worthy to note however, that anti-inflammatory drugs may not be beneficial to people with asthma, high blood pressure, kidney failure, or heart failure.
2. Paracetamol may be sufficient if taken regularly at full strength. It can also safely be taken in addition to anti-inflammatories.
3. Codeine,a stronger painkiller could also be an option if anti-inflammatories do not work well. Often taken in addition to Paracetamol, Codeine has constipation as a common side-effect. This may rather make the back pain worse because of the strain visit the toilet.
4. Diazepam, a muscle relaxant is sometimes prescribed if the back muscles become tense and makes the pain even worse.

• Exercise: General exercise is very important if one suffers a prolapsed disc. It strengthens the muscles that support the spine helps lessen the pain. A physiotherapist can give the best advice on what exercise would best suit which situation.
• Epidural: Performed by a specialist, this is an injection given into the back of a patient around where the sciatic nerve comes out of the spine. The injection contains a local an aesthetic and a steroid that is a very strong anti-inflammatory. It is essentially a painkiller that can give you pain relief long enough for one to begin or continue to exercise.

• Surgery: As a rule, Surgery may only be an option if the symptoms are very severe and have not settled after initial treatment. These cases are in the minority. Research reveals that in most of prolapsed disc cases, the symptoms eases off completely or don’t get bad enough to warrant surgery. The surgery is aimed at cutting out the prolapsed part of the disc and free the pressure on the nerves. Even though this often eases symptoms, it does not work in every case.

PREVENTION

Keep fit: Evidence suggests that the best way to prevent bouts of back pain and 'slipped' disc is simply to keep active and to exercise regularly.

This means general fitness exercise such as

• Walking,
• Running,
• Swimming, etc.

There is no firm evidence to suggest that any particular back strengthening exercises are useful than simply keeping fit and active. It is also sensible to be conscious of one’s back. For example, do not lift objects when you are in an awkward twisting posture.