slipped disc treatment

Lets understand the slipped disc/sciatica/disc prolapse in a simple way …

A normal disc is a very innocent structure and happily lies in between two adjacent vertebral bones doing its job of transmitting load from top to bottom in spine and providing cushioning effect at all times. Longstanding stresses to disc due to abnormal posture like people involved in desk job or people involved in lifting weights or people with poor core muscles, the disc may disrupt and cross its normal boundary. Most slipped discs don’t cause any problem to the patient. Only if a disc slips backwards and causes irritation of nerve roots lying behind the disc, it causes sciatica. Because only 35-40% discs irritate the nerve roots, only this percentage of patients perceive sciatica.

How does slipped disc cause sciatica?

We must understand this about basic human body. The nerve roots arise from our low back just behind the disc. These nerve roots form the main nerve (sciatic nerve) that travel down to your thigh, leg and foot. It is when this slipped disc irritates these nerve roots we start getting radiating pain from low back down to our thigh, leg and foot. These nerves also provide sensations to these areas, provide power to our lower limb joints like ankle and toes and also enable bowel and bladder control. This irritation of nerve roots by disc material can have the symptoms commonly known as sciatica. These symptoms are:

Radiating pain from low back to thigh, leg and foot
Numbness, tingling or heaviness of thigh, leg and foot
Weakness of ankle or toes. These are commonly perceived as inability to lift the foot off the ground while walking (foot drop) or inability to straighten the toes (toe drop)
Loss of bowel and bladder control in severe disc prolapse

Do all slipped discs require surgery?

As mentioned before, only 35-40% slipped discs irritate the nerve root and cause symptomatic sciatica. Out of the symptomatic sciatica also, most discs resorb with time either naturally or with conservative methods and only 10% of the symptomatic cases finally require surgery.

What are the conservative methods to manage sciatica?

REST: An acute attack of sciatica requires 3-5 days of bed rest. Bedrest beyond this period is not recommended as it would cause muscle deconditioning and weakness of core muscles, a factor contributing to cause of sciatica
PAINKILLERS: Analgesic medications for a period of 3-5 days may be given for severe pain. Painkillers reduce pain and inflammation relieving sciatica
PHYSICAL THERAPY: Initially cold packs for 3-5 days followed by hot packs help relieve inflammation and pain. Other modalities like TENS and IFT are also helpful. Once the pain settles, physical exercises are started with gradually increasing intensity. Exercises focus on core muscles and should always be performed under expert supervision
LIFESTYLE CHANGES: Following precautions at home and workplace are required

Regular exercises targeting the core muscles
Ergonomic chairs at workplaces for jobs demanding prolonged sitting
Avoid lifting weight or forward bending
Avoid prolonged driving

What is role of spine injections in slipped disc?

There are different of spine injections for different spine problems. Spine injections relevant to slipped disc is the epidural steroid injection or the selective nerve root block.

Spine injections are a mix of steroids and local anesthetics. They reduce the inflammation around the irritated nerve root and also they numb the nerve root causing pain relief.

The benefits of spine injections in slipped disc are as follows:

To delay or avoid surgery: Epidural steroid injections reduce inflammation around irritated nerve root, thereby it accelerates the natural healing process of a disc prolapse. This usually provides temporary relief from sciatica but in few cases relief may be permanent. This delays the need for surgery and in some patients, surgery is altogether avoided.
To aid in rehabilitation: Core strengthening exercises is a pivotal to healing of a disc prolapse and long term pain relief. In many cases, exercises and rehabilitation may not be possible due to chronic pain. Here epidural steroids act as useful tool along with other conservative methods.
To confirm the problematic disc: Whenever there is disc prolapse at multiple levels, despite clinical examination and MRI there may be a confusion which disc is irritating the nerve root and causing sciatica. In such cases an injection close to the nerve will numb it. This is called a diagnostic test and helps to pinpoint the offending disc.

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