Have you ever experienced excruciating back/neck pain ? The commonest cause is a bulging disc in your back/neck.
The human spine is made up of 33 Vertebrae which are interlocked with each other to form the Spinal column. Each vertebrae is separated from the next by intervertebral disc or simply 'disc'. These discs act as shock absorbers and provide the necessary flexibility to the spine. These discs are made up of jelly like substance (nucleus pulposus) contained in a hard shell(annulus fibrosus).
When the spine is strained during certain activities like lifting heavy objects, doing deadlifts or other athletic activities, the annulus fibrosus around the disc may tear and the jelly like nucleus may come out and press on the spinal cord or the nerves, this is called as disc bulge/disc prolapse.
Disc prolapse is a very painful condition and may lead to low back pain with pain going down the legs (sciatica) if the disc is prolapsed in the back or neck pain with pain going down the arms if the disc is prolapsed in the neck. If the compression is severe, pain may be complicated by neurological deficits or power loss in the arms or legs due to pressure on the nerves.
Diagnosis is pretty evident on clinical examination and confirmed by MRI scan of the neck or the back. Another test that should be done is standing X-Rays of the back/neck, bending forward and bending back(Flexion-extension view) as this demonstrates the stability of the spine.
Treatment options include conservative management with oral anti-inflammatory medications and physiotherapy, local corticosteroid injections around the inflamed area, and if none of these are relieving the pain or if there is severe or worsening neurodeficit on examination, final option is surgery.
Surgery generally involves laminectomy and discectomy to free the compressed nerve and remove the offending disc.
If the spine is unstable on Flexion Extension views or pain the back has been present for a long time or if the disc prolapses recurrently, Spinal Fusion surgery may be offered. The goal of spinal fusion is to completely remove the disc between 2 vertebrae, free up the nerves and make the segment into one solid price of bone. This can be done by many techniques and involves putting screws and rods in the bones from behind and generally, a cage between the vertebral bodies.
Rehabilitation out from spine surgery is generally 6 weeks and involves a fair amount of work both from the patient and from the physiotherapist.
Comments