Intervertebral disc is a normal structure present between two vertebrae which acts as a shock absorber for the spine during movement between the two vertebrae. As aging occurs, disc undergoes degeneration in the form of loss of water content of nucleus pulpous (desiccation) and annulus can develop cracks and tears, as result of it the disc loses it’s shock absorber property.
The PIVD /prolapsed intervertebral disc or slipped disc means the protrusion or extrusion of the nucleus pulpous through a rent within the annulus fibrosus and can sometimes irritate/compress the nerve leading to pain and numbness going down the legs/arms. Rarely, it can cause weakness in legs/arms along with bladder and bowel disturbances.
The PIVD (slipped disc) results when a desiccated disc is exposed:
- Bad sitting posture
- Prolonged stress
- Repetitive twisting
- Lifting activities or heavy manual labour.
In About 95% cases of disc prolapse occur in lumbar region, which is the lower part of the spine, usually L4-L5 & L5-S1 discs are most commonly affected.
Patient comes complaining of low back pain/neck pain, muscle spasm and usually the pain travels down the lower limbs from buttock, thigh to leg in case of lumbar disc prolapse or neck pain along with upper limb radicular pain, from shoulder to arm into fingers of hand, in case of cervical disc prolapse. Rarely, if the disc prolapse is severe, it can lead to compression of spinal cord/nerve roots leading to weakness in limbs or loss of bowel and bladder control. PIVD ( slipped disc) is diagnosed by taking detailed history and performing clinical examination which is supported with MRI and radiography.
Treatment options of PIVD include:
Conservative management in usually in the form of anti-inflammatory medication, physiotherapy & analgesics.
Selective nerve root blocks help in diagnosis as well provide variable relief of symptom. Still about 5-10 percent of patients with PIVD will have persistent pain and symptoms and require surgical management. Surgical management involves removal of prolapsed part of disc. It can be performed as standard open, microscopic and endoscopic discectomy.
Head of Dept.of Spine Surgery
Primus Super Specialty Hospital
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