Slipped Disc

A slipped disc also known as a herniated disc is the prolapse of spinal cord discs. The spinal cord is a structure constructed with 23 spinal discs. Spinal discs are cushioned box-like structures filled with internal contents. The internal contents comprise soft tissues, nerves, and other internal organs. 

A slipped disc occurs when the inner material slips out of the box and gets stuck. It causes severe pain, weakness, and a bulge or swelling in the back. The pain area depends on the nerve involved in the prolapse. Some people might not experience pain if prolapse excludes nerve compression.

Associated Anatomy

The spinal cord, spinal disc, and Spinal nervous system—lumbar, cervical, thoracic, and sacral nerves.

Signs and Symptoms of a Slipped Disc or Herniated Disk

The symptoms and signs are specific to the part of disc prolapse. If the prolapse is in your lower back, you will experience pain in your buttock, thigh, and calf muscles. You might not feel any pain if your nerves did not herniate. Some people won’t recognize a disc prolapse at all unless a spinal imaging procedure is performed.

Some symptoms of slipped disc are:

Severe Pain:

Pain in the neck, shoulder, and arm - if the disc slip is in the upper part of the spinal cord.

Back pain - if a disc prolapses in the lower part of the spinal cord.

Pain in the buttocks, hips, thighs, and legs - a disc prolapse pressing on the sciatic nerve.

• Numbness and tingling
• Limited movements: Movements are restricted to a certain extent. You might not be able to extend your body. You will experience some discomfort if you do so.
• Muscle weakness
• Excruciating pain in sudden movements: Shooting pains in the prolapse location during sudden movements like sneezing, coughing, and laughing.

Causes of a Slipped Disc

Several important causes of the slip disc are as follows:

• Aging: Spinal discs are nothing but cushion-like layers in between the bones. During the aging process, these discs are prone to rupture.
• Obesity: Being overweight is one important reason for a disproportionate weight balance. An unbalanced weight will lead to prolapses. Inactivity is also a contributing factor.
• Excessive work/stress on the spinal disc: Excessive strain on the disc can rupture and break it, leading to tearing and internal material spillage (herniation). Frequent rigorous exercises, heavy machine work, and heavy weight lifting are all examples of overstretching.
• Abnormal movements: Improper weight lifting, twisting positions, and stretches can sometimes lead to disc prolapsing.

Available Slip Disc Treatment

Slip disc treatment plans include medication, home therapies, surgery, and physical therapy.

• Medications: Pain killers, analgesics, muscle relaxants, and epidural injections for reducing swelling and pain.
• Home therapies: Home remedies are limited and temporary such as ice packs/hot packs, topical pain-relieving balms and sprays, bed rest, and regular painkillers - paracetamol, acetaminophen, etc.
• Surgery: Spinal decompression surgery, artificial disk replacement, spinal fusion surgery, etc.
• Physical therapy: It focuses on relieving pain through the use of minor physical exercises, bracing, traction, and electrotherapy.

Stages of Slipped Disc

A slipped disc or disc herniation is the spillage of internal contents (nucleus pulposus present inside the disc) out of the disc. Slipped disc can also be called herniation of the nucleus pulposus (HNP). There are five different steps in the pathophysiology of disc prolapse. The process of progression of slipped disc is:

• Disc degeneration (wall erosion)
• Disc protrusion (internal material penetration)
• Prolapsed disc (prolapsed internal material)
• Disc extrusion (complete prolapse)
• Sequestered disc (internal material spillage)

Risk Factors for Developing Slipped Discs

• Aging: The spinal discs weaken with increasing age.
• Sedentary lifestyle: Inactivity reduces overall strength and muscle power. Ultimately, the discs, ligaments, and muscles lose their ability to support the spine.
• Obesity: Excessive weight disrupts proper weight balance in the body.
• Heavy weight lifting/strenuous exercises
• Frequent vehicle driving
• Abnormal twisting stretches
• Occupational workload

The Possible Complications of a Slipped Disc

An untreated slipped disc can exacerbate the health condition.

The cauda equina is a bundle of nerve roots that emerges from the end of the spinal cord. It consists of parts of the lumbar, sacral, and coccygeal nerves. In rare cases, a herniated disc completely compresses the entire nervous system, including the cauda equina. In that case, emergency conditions like the following may arise.

• Bowel or bladder dysfunction (problems related to urination and stool passage)
• Progressing pain and numbness in the lower body
• Limitations in typical daily activities
• Progressive loss of sensations

Emergency surgery is the only Slip Disc treatment option at this stage. Otherwise, it might result in permanent paralysis, weakness, and bowel, and bladder dysfunction.

Tests for Slipped Disc

The doctor might perform a physical examination and strength tests followed by imaging procedures like MRI, CT, and X-ray.

X-ray is used to rule out other probable diagnoses. It does not, however, help in the diagnosis of a slipped disc.

Slip Disc Prevention

The Primary Prevention Techniques for a Slipped Disc

• Maintain a healthy physical body structure.
• Avoid heavy/extra weight-bearing activities.
• Take breaks during continuous driving routines.
• Familiarise yourself with the precautions and guidelines, before engaging in any gym activities.

The Secondary Prevention Techniques for a Slipped Disc

• If you feel pain in your back, take adequate rest.
• If you see a visible bulge near your spinal cord, do consult your doctor.
• If you have a medical history of disc prolapse, take additional care while lifting weights.

Epidemiology of a Slipped Disc

• A slipped disc is one of the most prevalent diagnoses. It affects up to 2% of the total population each year.
• A slipped disc or disc herniation is the leading cause of back pain.
• People between the ages of 30 and 50 are more prone to get a herniated disc.
• Slipped disc prevalence in men is two times higher than in women.

The Pathophysiology Behind Disc Herniation

Discs have soft internal materials like the nucleus pulposus and rigid external layers. If the outer layer weakens and breaks, the internal material spills out. The prolapse can compress the nearby spinal nerves. For a better understanding of the symptoms, consider the following:

• Cervical nerve: Pain in the neck, shoulder, and arms.
• Thoracic nerve: Pain radiating into the chest.
• Lumbar nerve: Pain extending towards legs through buttocks, thighs, and legs.