What Is A Prolapsed Disc?

The spine is a complex structure consisting of 33 vertebrae, including 24 articulating vertebrae and nine fused vertebrae in the sacrum and coccyx. Each vertebra is separated by an intervertebral disc. These intervertebral discs are soft and spongy and act as shock absorbers for the spine. They also contribute to the overall flexibility of the spine. The intervertebral discs are made up of an inner layer and an outer layer. The inner layer (nucleus pulposus) is soft and gel-like and the outer layer (annulus fibrosis) is tough and fibrous. The outer layer is responsible for holding in the inner layer.

A prolapsed disc, which may also be called a herniated, slipped, or ruptured disc, occurs when the nucleus pulposus herniates through the outer layer of the disc. The prolapsed disc then puts pressure on other structures in the spinal column, most notably, the spinal nerves. The pain that occurs with prolapsed discs is believed to be the result of nerve compression by the bulging disc. Inflammation around the affected nerve may also contribute to a patients’ pain.

The intervertebral discs of the lumbar spine are the most commonly herniated discs, although any disc of the spine may be affected. The extent of a disc herniation varies widely; in general, patients with larger bulges are expected to experience more severe pain.

Symptoms of a prolapsed disc can vary from patient to patient with some patients reporting sharp pain that is very localized while others report generalized, diffuse pain. Typically, the pain associated with a prolapsed disc will have a sudden onset of severe pain. Occasionally, the pain will be reduced when the patient lies down. Other symptoms of a prolapsed disc include numbness and tingling. Some patients report radiating pain (e.g. pain travelling down the leg to the foot, etc.) that results from nerve root pain that travels along the spinal column.

Causes Of Prolapsed Discs

Prolapsed-Disc-xrayResearch has been somewhat inconclusive as to why prolapsed discs occur. However, it is believed that some individuals have a predisposition to develop a prolapsed disc due to congenital weaknesses in the outer layer of the intervertebral discs. Some researchers believe that the intervertebral disc weaknesses can also be the result of normal wear and tear that occurs over time.

Factors that have been identified as being associated with prolapsed discs include:

  • Improper bending techniques
  • Frequent heavy lifting
  • Leading a sedentary lifestyle
  • Smoking
  • Obesity
  • Weight-bearing sports
  • Traumatic spine injuries

Treatments For Prolapsed Disc

Non Steroidal Anti-Inflammatory DrugsConservative, home treatment options should be tried initially in patients that are suffering from mild pain associated with a prolapsed disc. If an injury occurred, allowing the body to rest for the first several days is advised. After this, physical therapy, including stretching and strengthening exercises, can be started as they have been shown to be effective for patients with prolapsed disc pain. Swimming is a low impact activity that patients with prolapsed discs can participate in without the fear of aggravating their injured disc.

Pain medications that are available over-the-counter can provide relief for individuals suffering from mild to moderate pain. A non-steroidal anti-inflammatory medication is sometimes recommended for individuals suffering from more severe pain as they help to reduce inflammation of the affected area, and thereby help to reduce pain. Cortisone and prednisone are oral steroids that may also be recommended to help reduce inflammation and pain in the affected area.

Opioid medications, such as codeine, may be recommended for patients that do not respond to other forms of medication as they have been shown to be quite effective for pain management. Opioid medications work by binding to opioid receptors in the brain. Opioid medications are effective for the relief of short-term acute pain, but should not be used for long-term pain relief as the risk of dependency and abuse has been well documented.

Spinal-cord-stimulatorAdditional therapies are available for patients who do not respond to conservative treatment options. These therapies include spinal cord stimulation, TENS therapy, and epidural steroid injections. Spinal cord stimulation involves implantation of an electrical impulse device near the spinal cord that helps to control pain signal transmission from spinal nerves. TENS therapy uses a small device that delivers mild electrical impulses to the affected area via electrodes attached to the skin, modifying pain signal transmission. Epidural steroid injections involve injecting an anesthetic and steroid into the affected area to essentially block the pain signals.

Alternative treatment options, including biofeedback training and acupuncture, have also shown to be effective for pain management, when used in combination with other therapies, for individuals suffering from a prolapsed disc.

Conclusion

Prolapsed discs occur due to changes in the intervertebral discs of the spinal column. They occur when the inner layer of the disc is able to bulge out because of weaknesses in the outer, fibrous layer. The prolapsed disc compresses nearby nerves leading to chronic pain in the affected area. Although any intervertebral disc in the spine can be affected, those in the lumbar region are the most commonly affected.

There are various treatment options for prolapsed discs ranging from conservative home therapies to more aggressive treatment options. Patients are encouraged to speak to their physicians about the extent of their symptoms to determine what treatment methods may provide the most benefit for their condition.

References

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