Before discussing a slipped disc, it is important to understand the anatomy of the vertebral column. The vertebral column, also known as the backbone or spine, is a series of conjoined bones that provide protection, support, and movement to the human structure. The backbone is made up of 33 bones called vertebrae. It runs from the neck down to the lower back and is segmented into five- cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacrum, and coccyx.
Located in between each vertebra are discs called the intervertebral or spinal disc. The spinal discs are like pads and act as shock absorbers. The discs are designed so that each disc consists of an outer band that looks like a tire called the annulus fibrosus and an inner gel-like substance called the nucleus pulposus.
When a slipped disc occurs, it can affect the entire movement of this skeletal section. The adjacent vertebrae, blood vessels, connective tissue, and nerves might be affected. This occurrence is common in the lower back and the neck region.
Natural Treatment –
Prolotherapy is treatment that involves the injection of a regenerative solution just outside of the slipped disc. Spinal discs don’t have a great blood supply which is why they struggle to get better on their own. It is the oxygen and nutrients in our blood that help to repair and strengthen damaged and weak areas if the body. Prolotherapy helps the disc by reducing pain and inflammation, repairing micro-tears in the outer rings, and strengthening the structures around it. View our video testimonials of patients on the ‘review’ page of our website.
Slipped disc: Overview and epidemiology
A slipped disc, also called herniated disc, is when the gel covering the spinal disc, which acts as a cushion between the vertebrae, pushes out. Spinal disc herniation means that the nucleus pulposus is displaced from the intervertebral space.
A slipped disc is one of the common causes of back pain. However, unlike the typical mechanical back pain, pain resulting from a slipped disc is often stinging and burning and typically radiates into the lower extremity. There are some cases where herniated disc doesn’t cause the patient any pain. For such asymptomatic patients, MRI is used to detect the herniated disc.
A slipped disc occurs in about 5 to 20 cases per 1000 adults each year. It is more prevalent in people aged 30 to 50 years. It occurs with a male to female ratio of 2:1. Disc disease is the underlying cause of back pain in nearly five percent of patients. A slipped disc occurs more in the lumbar region. There are about 1 to 3 percent cases of asymptomatic herniated lumbar disc in Italy and Finland. According to a study, patients aged 25 to 55 years have a 95% likelihood of slipped disc occurring either at L5-S1 (fifth lumbar vertebra to first sacral vertebra) or L4-l5 (fourth lumbar vertebra to fifth lumbar vertebra).
Pathology and etiology of slipped disc
A slipped disc is when part or the entire intervertebral disc cushion (nucleus pulposus) herniates and protrudes through the annulus fibrosus. The most common cause of this is degeneration that occurs as a result of aging. As humans age, the nucleus pulposus weakens and becomes less hydrated. When this happens, there will be a progressive herniation of the disc, which can present with other symptoms.
Another common cause of slipped disc is trauma to the vertebral disc. Other causes of a herniated disc include disorders of the connective tissue and congenital problems such as short pedicles.
Factors that have been suggested as influencing the etiology of herniated disc include:
- Compressive loading
- Genetic factors
- Stress and vibration
- Systemic and toxic factors, e.g., nutrition, metabolic disorders, infections, and inflammations
The mechanical factors will trigger biochemical factors, which will, in turn, cause degeneration of the disc. Degeneration of the spinal disc will occur if the disk matrix is abnormal, which will be evident in the form of structural changes and impaired disc function.
Disc slip occurs more in the lumbar and cervical vertebrae because of the biomechanical forces in these flexible parts of the vertebral column. The vertebral segment with the lowest rate of herniation is the thoracic vertebrae.
Clinical presentation and diagnosis of slipped disc
How do clinicians diagnose slipped disc? Most times, disc herniation is preceded by bouts and different degrees of back pain. Sometimes, the cause of this back pain is not known. The pain eventually goes beyond the back region and radiates towards the leg. The pain is usually described as stabbing, burning, or shooting (just like an electric shock).
Lumbar disc herniation, which is the most common, usually causes pain by the lateral (outer part) and anterior (front part) of the thigh and leg. Pain occurred when the slipped disc damages a nerve. A numb and tingling sensation accompanies the pain. If the pain is not disabling, the patient might not notice the accompanying muscle weakness. The pain typically reduces if the patient is lying facing up with the eggs slightly elevated. Patients usually get some relief when they change positions or when they take long walks.
When examined, patients who have herniated discs may be normal neurologically or show a cauda equina syndrome or significant radiculopathy. The spine may curve abnormally lateral, as in the case of scoliosis. The patient’s gait is typically affected, and walking on heels and toes may reveal weakness.
When diagnosing slipped disc, physicians also order imaging tests. The imaging tests that might be carried out include X-rays, MRI, myelogram, and CT scan. Nerve tests that can help ascertain the location of nerve damage include electromyography and nerve conduction study.
Treatment of slipped disc
For most patients, conservative treatment and pain medication relieves symptoms within some days or weeks.
People with a slipped disc are advised to stay active as lying in one position for a long time can cause muscle and bone weakness. According to studies, physical activeness can help improve mobility.
Exercise therapy and relaxation exercises might also help relieve back pain. The mind can influence how pain is perceived; thus, learning coping mechanisms might help deal with the symptoms. However, if the pain becomes severe, patients are advised to lie down or find a position that puts less strain on the back.
Different medications can help relieve pain caused by a slipped disc. Doctors might also prescribe for patients anti-inflammatory drugs as well as muscle relaxants. Examples of some medications for treating slipped disc symptoms include acetaminophen, non-steroidal anti-inflammatory drugs, antidepressants, muscle relaxants, and steroids.
There are few cases where herniated discs require surgery. Surgery is usually the last option when other treatment options fail to improve symptoms after about six weeks.
Surgery to treat slipped disc requires that the surgeon removes either the protruding portion of the disk or the entire disk.