Relevant Anatomy

The intervertebral disc is a fibro cartelagenous disc situated in between the two adjacent vertebra. It has

• Nucleus pulposus this is the central portion which is under pressure all the time.

• Annulus fibrosus this is the fibrous tissue surrounding the nucleus pulposus and holding it in place.

Signs and sympotms

The commonest site of spine where the disc prolapsed occurs is at the level of L4-L5 spine at the back and C5-C6 spine in the neck

L4-L5 disc prolapse cause

• L4-L5 disc prolapse cause
• Pain in the lower back which increases on coughing, straining, exertion
• Lower back Pain radiating to the back of the thigh-sciatica

C5-C6 disc prolapse causes

• Pain in the neck

• Neck pain radiating to back of the arm

Neurological symptoms

• Numbness,
• pins and needle sensation,
• weakness
• Paresthesia
• UMN type of paralysis in cervical disc prolapse
• LMN type of paralysis in lumbar disc prolapsed
• Cauda equina syndrome

Tests and diagnosis

Physical examination

• Tenderness of the spine,
• Straight leg raising test(SLRT) – is positive in the lumbar disc prolapsed
• Weakness and or sensory disturbance in the limb affected

Imaging

• X ray of the spine- X-ray examination will not show the disc prolapsed but done to rule out the bone injury
• CT scan- will show the size and shape of the region affected
• MRI scan- this is the investigation of choice if at all surgery is considered.

• Myelogram – in this the contrast medium is injected into the spinal canal and sequential X-rays are taken. This is an invasive procedure and MRI has replaced the myelogram

• Electromyogram and nerve conduction studies

Treatment and management

Conservative treatment

The initial line of management is conservative and the usually the cervical disc prolapse responds well to the conservative line of management.

1. Rest

• Absolute bed rest in acute situation
• Lumbar belt supported ambulation
• Cervical collar supported ambulation

2.  Analgesics

• Oral NSAIDS
• Oral steroids
• Epidural injection of steroids
• Intra venous sedation or analgesic assisted traction therapty

3.  Physiotherapy

• Physical therapy
• Massage therapy
• Heat therapy
• Infra red therapy

4. Weight reduction

5. Chiropractic

Surgical management

Surgical management is considered when the conservative line of management do not offer relief, when there is progressive deterioration in the neurological symptoms, presence of UMN or LMN type of paralysis.

Here the prolapsed, nucleus pulposus exerting pressure on the spinal cord or nerve root is removed, relieving pressure on the nerve.

• Micro discectomy
• Laminectomy
• Hemilaminectomy
• Spinal arthrodesis

• Disc arthroplasty

• Nucleoplasty

Complications

• Nerve root compression
• Spinal cord compression leading to UMN or LMN type of palsy
• Degenerative arthritis