Slip Disc

The discs between the bones of the spine act as cushions, with a soft jelly-like centre and a tough outer ring. In a slip disc, also called disc herniation or prolapse, the disc does not actually slip out of place; part of the soft centre pushes out through a weak area in the ring and may press on a nearby nerve. It is most common in the lower back and also occurs in the neck.

Symptoms

• Lower back disc: pain from the buttock down the back or side of the leg, often to the foot (sciatica), usually worse than the back pain
• Neck disc: pain spreading from the neck into the shoulder, arm or hand
• Tingling or numbness in the leg, foot, arm or fingers
• Weakness, such as difficulty standing on the toes or heels, or a weak grip
• Pain that worsens on coughing, sneezing, straining or sitting for long

Causes

• Gradual weakening of the discs with age
• Lifting heavy objects with a bent back, especially while twisting
• Long hours of sitting or driving and lack of exercise
• Excess body weight and smoking

Diagnosis

A neurological examination checks muscle strength, reflexes and sensation, and simple tests such as raising the straightened leg show whether a nerve is compressed. An X-ray cannot show the disc itself, so an MRI is the main test when symptoms persist, are severe or come with weakness. MRI scans often show disc bulges in people without any symptoms, so the scan is always interpreted together with the examination.

Treatment

Most people with a slip disc get better without surgery. Over weeks to a few months, the herniated part of the disc often shrinks on its own and the nerve recovers. Treatment in this phase includes a short period of relative rest followed by a gradual return to normal activity, medicines for pain and nerve pain prescribed by your doctor, and physiotherapy to strengthen the back and core muscles. Learning safe ways to bend, lift and sit helps prevent recurrence. An epidural or nerve root injection may be advised if leg or arm pain remains severe.

Surgery is recommended when pain continues despite about six weeks or more of proper treatment, when weakness is worsening, or urgently if the bladder or bowel is affected. In the lower back, the usual operation is a microdiscectomy, in which only the herniated fragment is removed through a small incision using a microscope. In suitable patients this can be done by endoscopic or other minimally invasive spine surgery. For a slip disc in the neck, the disc is usually removed from the front and the level stabilised. The choice depends on the examination and MRI.

When to Seek Urgent Care

• Numbness in the saddle area: around the private parts, buttocks and inner thighs
• Difficulty passing urine, or loss of bladder or bowel control
• Rapidly increasing weakness in a leg, or foot drop
• Pain or weakness in both legs at the same time
• Severe back pain with fever, or after a major injury

These may indicate serious nerve compression (cauda equina syndrome). Go to the nearest emergency department immediately.

If you have sciatica, arm pain or a slip disc, consult Dr. Prashant Sharma at Keshav Super Speciality Hospital, Meerut, for an evaluation and a clear treatment plan.

Related Conditions

• Spinal Nerve Pain (Radiculopathy)
• Spinal Paralysis
• Spine Tumour
• Spine Fracture
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