Disc prolapse

What is a disc prolapse?

The vertebrae in your spine are linked together by discs, which contain soft, cushioning tissues. If there’s a weakness in a disc’s outer shell, tissues can bulge out, pushing against a spinal nerve. This can trigger severe back pain, often lower back pain. A prolapsed disc can cause severe back pain due to a problem with one of the discs connecting the vertebrae in your spine. A prolapsed disc is also known as a slipped or a herniated disc.

What causes the condition?

As with other joints in our body, discs, are prone to a degree of ‘wear and tear’ as we age. This is partly due to the amount of strain we expose them to as a consequence of physical activities we undertake. It is also genetically determined and undoubtedly some people’s discs are more resilient than others. As a consequence, disc prolapses do tend to run in families. The amount of wear in any given disc is also dependent upon the amount of movement possible in that part of the spine. Therefore, the more mobile parts of the spine in the neck and lower back are where discs tend to wear the most.

A prolapsed disc is more likely if you’re 30 to 50 years old, with men twice as likely to be affected. Factors which increase the risk of a slipped disc include:

• Occupations involving lots of lifting or sitting
• Weight-bearing sports such as weightlifting
• Smoking
• Being overweight
• Being inactive

What are the typical signs?

The first sign of disc prolapse is often sudden, severe back pain. Spinal stenosis can also be an indication of a slipped disc.
Other symptoms include:

• Tingling and/or numbness in your shoulders, back, arms and hands
• Neck pain
• Back pain
• Sciatica – pain, tingling and/or numbness in your buttocks, hips, legs and feet resulting from pressure on the nerve in your spine
• Loss of muscle strength

There’s also a rare nerve condition which affects the base of the spinal cord called cauda equina syndrome. Contact your doctor immediately if you have lower back pain accompanied by any of the following symptoms:

• Bowel or bladder problems
• Numbness around the bottom of your spine
• Weak leg muscles

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and perform a medical examination, which may be followed up by an X-ray or MRI scan. This will reveal the location and severity of your prolapsed disc and will help rule out degenerative disc disease

Treatment

Non-surgical treatment: Muscle relaxants, anti-inflammatory painkillers or a steroid injection might be recommended by your consultant. They may also suggest spine-strengthening exercises, physiotherapy or spinal manipulation.

Surgery: As a rule, an operation is generally only considered if the symptoms are very severe and have not settled after at least six weeks. This is the minority of cases, as in around 90% of people with a prolapsed disc, the symptoms have eased off completely or are not bad enough to warrant surgery by this time.

Your consultant will recommend the most appropriate operation for you, three of the main procedures used are:

• Laminectomy – where a section of bone is removed from one of your vertebrae (spinal bones) to relieve pressure on the affected nerve
• Discectomy – where a section of a damaged disc is removed
• Spinal fusion – where two or more vertebrae are joined together with a bone graft

Recovery

This depends on the type of treatment you’ve had. The average stay in hospital is one to two nights and by discharge you will be mobilising freely and able to climb a flight of stairs. Full soft tissue recovery normally takes about six weeks.

When can I return to normal activities?

Work - this depends on your individual employment and lifestyle, however if your job mainly involves sitting then an approximate guide is around four weeks post-surgery. If you have a more active role, your consultant will be able to advise you on a suitable period of time, however it could take up to two months
Driving – usually about two weeks
Exercise – usually just walking for six weeks, then low impact exercise 6-12 weeks

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