Herniated or Slipped Disc

Definition of Herniated Disc / Slipped Disc

Herniated disc talks about the problem with one of the rubbery, cushion-like pads (discs) between each vertebra that act as shock absorbers. It occurs when the fibrous outer portion of the spinal disc/s tears or ruptures, letting the soft jelly-like core seep out to the spinal canal. When the herniated disc presses the nerve, it may cause numbness, pain or weakness in the legs, and might lead to sciatica.

 

Causes of Herniated Disc / Slipped Disc

The most often cause of disc herniation is related to disc degeneration or the gradual wear and tear of the disc as you age. The spinal disc becomes less supple as its water content slowly subsides. This makes the discs more susceptible to splitting or tearing, even with a minor twist or bend. Lifting of heavy objects without bending the knee may also lead to herniated disc.

 

Symptoms of Herniated Disc / Slipped Disc

Most cases of herniated disc happen in the lumbar spine or the lower back part. Unless you see the spinal images, a herniated disc is not easily detected as people who have no signs of a disc problem might also have it. Here are the most frequent symptoms of herniated disc:

  • Muscle weakening – the muscles that are served by the affected nerves may become weaker. This might cause you to topple or fall.
  • Numbness/Tingling – the body part with the affected nerves might experience numbness or tingling.
  • Pain in the lower body – the severe spine surgeon may be felt in the buttocks, legs and/or feet when you perform rapid movements like sneezing or when you move your spine into particular positions.

 

Risk Factors for Herniated Disc / Slipped Disc

Herniated disc can occur at any age, but it usually happens to people who are in their 20s or 30s. Listed below are the risk factors that can prompt its occurrence:

  • Genetics – the predisposition to herniated disc might be inherited
  • Lifestyle - lack of regular exercise, smoking, and nutrition deficiency can be a significant influence to poor disc health
  • Occupation - physically demanding jobs that require bending, lifting, pushing, pulling and twisting can increase the likelihood of herniated disc
  • Posture - poor posture and the constant utilisation of improper body mechanics strains the spinal discs in the lower back
  • Weight – excessive body weight puts more pressure on the discs in the lumbar spine

 

Herniated Disc / Slipped Disc Diagnosis

In most cases, the doctor can diagnose slipped disc through physical or neurological exam and a review of the patient’s medical history. However, if the doctor needs more information about the disc problem or presumes that there is another condition, one or more of the following tests might be requested:

Nerve tests

Some of the nerve tests used to diagnose herniated disc are the EMG (electromyogram) and nerve conduction. These tests help find the location of the nerve damage as they evaluate how well the electric impulses move along with the nerve tissue. It also measures the electrical activity of the muscles when they're active and stationary.

Imaging tests
  • X-rays
    Ordinary x-rays are performed not to detect slipped disc, but to exclude the other causes of back pain like a broken bone, spinal alignment issues, or a tumour.
  • Computerized tomography (CT scan)
    A CT scan is performed to validate the location and degree of the disc impairment. It shots a series of x-rays from various directions and combines them to generate the cross-sectional images of the spinal column and the other parts around it.
  • Magnetic resonance imaging (MRI)
    MRI is used to identify the specific position of the slipped disc and affected nerves. This imaging test utilises radio waves and strong magnetic pulses in order to produce detailed images of the body’s internal structure.
  • Myelogram
    Myelogram is the process of injecting a dye into the spinal fluid and then x-rays are taken. This imaging test can display the pressure on the spinal cord and nerves, as a result of herniated discs and other conditions.

 

Surgical Treatment for Herniated Disc / Slipped Disc

Herniated discs are normally relieved after a number of weeks (usually from four to six weeks through a course of non-surgical treatments like medication or therapy.) However, if the symptoms persist or the conservative treatments fail to relieve the pain from herniated discs, this surgical treatment is often recommended:

  • Microdiscectomy
    Microdiscectomy is used to treat nerve compression from a herniated disc. The process gives more space on the nerve root as it releases the pressure by removing the herniated part of the disc that is initiating the pain. It uses a special microscope to examine the disc and nerves. This allows the surgeon to use a smaller incision (minimally invasive) in order to incur less damage on the surrounding tissue. Before the disc material is removed, laminotomy or laminectomy may be performed in order for the surgeon to better view the herniated disc. It is when the lamina (small piece of bone) from the affected vertebra that covers the nerve is eliminated.

 

Dr Chua Soo Yong is an Orthopaedic and Specialist Spine Surgeon who is experienced in the management of Slipped Disc.

Article Courtesy of Dr Chua Soo Yong
For more information, please call 6262 0555 or email drchua@aog.com.sg