Sunday, May 4, 2014
CERVICAL AND LUMBAR DISC DISEASE
Disc is the soft tissue located in between the vertebral bodies.
A picture showing different types of disc problems.
Disc problems are common in cervical (neck) and lumbar (lower back) regions. Earlier, it was common in older people, due to more degeneration of discs in them. However, now-a-days, we see several younger people, even in their 20s and 30s, who come with disc problems. This is because of sedentary life style, lack of exercises, prolonged sitting (on account of job, computer use, etc), and sports injuries.
What are the common symptoms of disc diseases?
Disc prolapse or slipped disc can present with several symptoms:
In cervical disc disease, following symptoms are common:
1. Neck pain,
2. Pain in the arm, which may increase on coughing,
3. Tingling or pins and needle sensations in the arm,
4. Numbness in arm,
5. Weakness in the arm.
In lumbar disc disease, the following symptoms may occur:
1. Lower back pain,
2. Pain in the leg, which may radiate from lower back to the leg, also referred to as sciatica,
3. Tingling or numbness in leg,
4. Weakness of leg,
5. Leg pain, numbness or weakness may increase on walking (referred to as claudication), and get relieved on resting.
How is the diagnosis of disc disease confirmed?
1. Clinical history and examination by a neurologist are useful in suspecting the diagnosis.
2. MRI of spine (cervical or lumbar region, as the case may be) is the confirmatory test for disc disease.
An MRI scan of lumbar spine showing a prolapsed disc at L5-S1 level
What are the treatment options for disc disease?
Conservative (without surgery): It is useful to note that surgery is not needed in about 90% of cases.
Several measures are useful in relieving pain in patients with disc prolapse:
1. Rest- in severe cases, bed rest may be advised. In less severe cases, limited mobility within the house (for toilet and dining purposes) may be permitted.
2. Use of analgesics (such as aceclofenac, etoricoxib) and muscle relaxants (such as mobizox and myospaz forte) may help in relieving pain.
3. Specific medications that help reduce the nerve pain are pregabalin, gabapentin, duloxetine, etc.
4. Physiotherapy- measures such as IFT, ultrasound, traction, etc help reduce the pain in several people with disc prolapse.
In 10% of patients, medical treatment fails, then, surgery may be needed. Following are the specific indications for surgery in a patient with slipped disc:
1. Failure of medical treatment to adequately control the pain,
2. Progressive neurological deterioration, such as worsening of weakness or numbness, or bladder/bowel involvement,
Various types of surgeries are:
3. Spine stabilisation with instrumentation.
The choice of surgery depends on patient's symptoms, MRI findings and age.
General advice to patients with disc disease:
1. Avoid forward bending,
2. Avoid lifting heavy weights.
3. Lose weight, if overweight or obese
What is the prognosis of patients with disc disease?
In general, the outcome of patients with disc prolapse is good and most patients return to normal life after proper treatment. They are able to do their activities of daily living and are gainfully employed.
Surgery is also safe, however, I come across many people who have wrong notions about surgery. They have been mis-informed that after surgery, people get paralysed. In practice, this does not happen. However, if the case for surgery is not correctly chosen, there may not be good relief from pain after surgery also, a condition referred to as "failed back syndrome".
If you have any further queries, you may get back to me.
Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist,
Apollo Hospitals, Hyderabad, India
Online consultation: http://bit.ly/Dr-Sudhir-kumar