Slipped Disc

The spine, consisting of 33 vertebrae, protects the spinal cord and provides structural support to the body. Intervertebral discs are positioned between these vertebrae, providing flexibility and absorbing shocks.

A slipped disc, more accurately termed a herniated or prolapsed disc, occurs when an intervertebral disc, which acts as a cushion between the vertebrae in the spine, becomes damaged and presses on the nerves. This condition often results from age-related wear and tear, known as disc degeneration.

The development of a herniated or slipped disc is often attributed to a combination of factors that contribute to the degeneration and subsequent injury of the intervertebral disc. Some of the common causes include:

• Natural Wear and Tear
  As people age, intervertebral discs lose hydration and elasticity, becoming more susceptible to tearing or rupturing, even from minor strain or twisting movements.
• Reduced Disc Height
  The dehydration of discs over time leads to reduced disc height, increasing the likelihood of disc herniation due to lessened shock absorption.
• Heavy Lifting
  Improper lifting techniques, especially lifting heavy objects, can exert excessive pressure on the spine, leading to disc injuries.
• Sudden Movements
  Sudden, awkward movements can cause the soft material of the disc to protrude.
• Obesity
  Excess body weight increases the load and stress on the lower back, contributing to the risk of developing a slipped disc.
• Sedentary Lifestyle
  Lack of regular exercise can lead to weak back and core muscles, less support for the spine, and an increased risk of disc problems.
• Family History
  There can be a genetic component, predisposing individuals to disc degeneration and associated complications.
• Repetitive Activities
  Jobs involving repetitive lifting, bending, or twisting can increase the risk of a slipped disc.
• Prolonged Sitting
  Occupations requiring long periods of sitting, especially with poor posture, can contribute to spinal disc deterioration.

Accurate diagnosis of a slipped (herniated) disc is crucial for effective treatment. The process typically involves several steps to understand the symptoms and determine the exact cause of the pain:

• Initial Evaluation: An orthopaedic surgeon will start with a thorough medical history review. This includes questions about the onset, nature, and severity of symptoms, as well as any activities or incidents that may have triggered them.
• Physical Examination: The examination focuses on identifying the source of pain and neurological deficits. This may include checking for tenderness over the spine, assessing the range of spinal motion, testing muscle strength and reflexes, and conducting specific manoeuvres to replicate the pain.
• Neurological Assessment: To evaluate nerve function, the orthopaedic surgeon may test muscle strength, reflexes, walking ability, and the ability to feel light touches, pinpricks, or vibration.
• MRI (Magnetic Resonance Imaging): This is the most commonly used imaging test for diagnosing a slipped disc. It provides detailed images of the disc, spinal cord, and surrounding structures, helping to pinpoint the location and extent of disc damage.
• CT Scan (Computed Tomography): Sometimes used in conjunction with or as an alternative to MRI, a CT scan provides detailed cross-sectional images of the spine and can reveal slipped discs and other spinal abnormalities.
• X-ray: Although X-rays cannot detect a slipped disc, they can be used to rule out other causes of back pain, such as spinal fractures or misalignment.
• Electrodiagnostic Testing: This includes electromyography (EMG) and nerve conduction studies, which can help confirm nerve compression caused by a slipped disc and provide information about the severity of the nerve damage.

Surgical intervention for a slipped disc is typically considered when non-surgical treatments fail to provide relief, or in cases where there is significant nerve impairment or severe symptoms. Common surgical options include:

• Microdiscectomy
  This is the most common surgery for a slipped disc in the lumbar region. It involves the removal of the portion of the disc that is pressing on the nerve root.
• Laminectomy
  In some cases, especially when there is a narrowing of the spinal canal (spinal stenosis), a laminectomy may be performed. This involves removing part of the bone, the lamina, from the affected vertebra to relieve pressure on the spinal nerves.
• Artificial Disc Replacement
  This is a newer surgical procedure that involves replacing the damaged disc with an artificial one. It is mostly used for the cervical spine and aims to maintain more natural movement of the spine compared to traditional fusion surgery.
• Spinal Fusion
  In cases where there is instability in the spine, a spinal fusion may be necessary. This procedure involves fusing two or more vertebrae together to prevent movement and alleviate pain.

While it is not always possible to prevent a slipped disc, certain measures can be taken to reduce the risk and maintain spinal health. Key prevention strategies include:

• Regular Exercise: Engaging in activities that strengthen the back and core muscles helps support the spine. Low-impact exercises such as swimming, walking, or cycling are beneficial. It is also important to include flexibility and stretching exercises in the routine.
• Proper Lifting Techniques: When lifting objects, it is crucial to use the legs rather than the back. This means bending at the knees and hips, keeping the back straight, and holding the object close to the body.
• Ergonomic Workstations: For people who spend long hours at a desk, ensuring an ergonomic setup can reduce strain on the back. This includes a chair with proper lumbar support, keeping the computer monitor at eye level, and taking regular breaks to stand and stretch.
• Avoiding Smoking: Smoking can reduce blood flow to the discs, leading to quicker degeneration and increased risk of injury.