Prolapsed/herniated disc

Question 1

What is the defintion of a prolapsed/herniated disc?

Answer 1

Damaged disc of cartilage that is pressing on nerves

Question 2

How common is a prolapsed/herniated disc?

Answer 2

Most common in ages 30-50. Twice as many men are affected than woman

Question 3

What is the pathophysiology of a prolapsed/herniated disc?

Answer 3

• Annulus fibrosus around the disc degrades/damaged
• Nucleus pulposus bulges out through a weakness in annulus fibrosus
• Sciatic nerve is often affected

Question 4

What are the risk factors/aetiology of prolapsed/herniated disc?

Answer 4

• Age
• Smoking
• Bending awkwardly
• Heavy lifting
• Sitting for long periods of time
• Overweight
• Injury to the back

Question 5

What are the signs/symptoms of a prolapsed/herniated disc?

Answer 5

• Asymptomatic
• Severe and sudden back pain – eased by lying down, made worse if back is moved, coughing or sneezing
• Neck pain
• Unilateral leg/hip/buttock pain – if sciatic nerve involved
• +ve leg straightening test
• Numbness
• Tingling sensation
• Weakness
• Loss of tendon reflex – red sign
• +ve Babinski reflex – red sign
• Look out for cauda equine syndrome! – saddle anaesthesia, urinary retention, faecal incontinence, laxity of anal sphincter, weakness in one or both legs

Question 6

What investigations are required to diagnose a prolapsed/herniated disc?

Answer 6

• Nerve conduction test
• X-ray
• MRI

Question 7

What are the surgical treatments for prolapsed/herniated disc?

Answer 7

• Surgery to free compressed nerve
• Disctectomy - removal of part of disc
• Prosthetic intervertebral disc replacement
• Percutaneous intradiscal laser ablation

Question 8

What are the pharmacological treatments for prolapsed/herniated disc?

Answer 8

• Analgesia
• Benzodiapepine
• Tricyclic antidepressants/gabapentin

Question 9

What are the non pharmacological treatments for prolapsed/herniated disc?

Answer 9

• Physiotherapy
• Chiropractor
• Osteopath – manipulation
• Keep active
• Heat
• Massage
• Do nothing