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INTERVERTEBRAL DISK PROLAPSE

Definition

Intervertebral disc prolapse is the protrusion or slipping out of one of the rubbery cushions (disks) which are present in between two vertebrae that make our spine or vertebral column.

The vertebral disk is a rubbery substance which has a jelly-like center with hard external covering. Disk prolapsed or herniation of the disk means that this jelly-like central substance comes out through a break in the outer hard covering.

The prolapsed disk can irritate the nerve which lies nearby and thus gives rise to abnormal sensations like a weakness of arms or legs, numbness or pain.

Symptoms

Some people have protrusion of the intervertebral disk without experiencing any symptoms. The disease may thus go unnoticed and the patient may suffer from a severe disease in the future.

Mostly disk prolapse is seen in the lower back (lumbar spine) or in the neck (cervical spine).

The common signs and symptoms of the prolapsed disk are:

Pain the arms or legs:

  • if the prolapsed disk is in the lower back (lumbar spine), the pain is felt very severely in the buttocks, thighs and the calf. It may also involve a part of the foot.
  • If the prolapsed disc is in the neck, the pain is felt in the shoulders or arms.
  • The patient may experience shooting of the pain in the arms or legs when the patient moves the spine in certain ways. Pain is more while coughing or sneezing.

Numbness or tingling sensation:

  • the nearby nerves get irritated due to the prolapsed disk. Due to this, the patient experiences numbness or tingling in those parts of the body which are supplied by the affected nerves.

Weakness:

  • the muscles that are supplied by the affected nerves become weak and the patient feels weak to lift anything in hands or stumbles while walking.

Causes

Disk prolapse is due to the degeneration of the disk that lies between the two vertebrae. Degeneration of the disk occurs due to loss of water content in the disks. Due to the loss of water content, disks lose their ability to stretch as needed during the movement of the spine and becomes more prone to rupture or tearing with even a small twist or pressure.

The exact cause of a prolapsed disk goes unnoticed due to the absence of immediate signs and symptoms. However, it is mostly caused by:

  • Lifting heavy weights using back muscles instead of the muscles of thighs or legs.
  • Twisting or turning while lifting.
  • Trauma to the back due to a fall or a blow can lead to prolapse of a disk.

Risk factors

  • Obesity: Extra body weight causes more pressure on the disks in the lower back causing them to slip away from their original position.
  • Occupation: people doing heavy works like lifting, pulling, pushing, bending sideways, twisting can also increase the risk of causing a prolapsed disk.
  • Genetics: some people have a family history of prolapsed disk and can inherit genes for it from their parents.

Diagnosis

A physical examination with a proper history of the patient’s condition may be enough to diagnose a case of disk prolapse.

Physical examination:

The patient is asked to lie flat on the back. Then he/she is asked to move his legs and hands in various positions to know the exact cause of pain.

Neurological examination is done to check for all the reflexes, the strength of the muscles, the ability to walk and the ability to feel the fine touch, pain or vibration.

To confirm the diagnosis and to rule out other conditions that can cause similar signs and symptoms, certain tests can be advised like:

  • X-ray: to see the prolapsed disk and to rule out other conditions of back pain like tumors, infections or fractures.
  • CT scan and MRI scan: this shows the exact location of the prolapsed disk and also shows which nerves are affected.
  • Myelogram: in this test, a small amount of a dye is injected into the spinal fluid before taking the X-rays. This test shows the pressure on the spinal cord due to multiple prolapsed disks or any other reason.
  • Electromyograms and nerve conduction studies: these tests measure how well the electrical impulses move along the nerve tissue. This can give an idea where exactly the nerve is damaged.

Self help

  • Avoid doing heavy works like lifting, pulling or pushing heavy objects etc.
  • Take proper rest. But do not rest for a long time as it can lead to stiffness of the joints and muscles making it more complicated to heal. Resting for about 30minutes followed by a short walk or minor works which do not need much exertion can be done regularly.