What is Intervertebral Disc Prolapse?
Pelvic intervertebral disc prolapse is commonly referred to as slipped disc. This is a misnomer as there occurs no actual slipping of the vertebral disc but actually, a protrusion or bulging occurs known as a hernia or a vertebral hernia. It presents with mild to severe symptoms, depending on the condition but can be managed effectively with appropriate treatment. Let us understand the causes, symptoms, diagnosis, treatment and preventive tips for intervertebral disc prolapse.
The pelvic intervertebral disc prolapse can enter the spinal canal, squeezing the spinal cord. The spinal nerves can get affected and causes varying symptoms of intervertebral disc prolapse. While the causes of intervertebral disc prolapse can be many, certain risk factors can increase the chances of its occurrence.
Intervertebral disc prolapse is rare in children and are more common in young and middle-aged adults.
Intervertebral disc prolapse usually occurs as a sudden onset, but in some cases can be gradually progressive due to some underlying pathology or previous trauma.
Causes of Intervertebral Disc Prolapse
Some of the commonest triggering factors or causes of intervertebral disc prolapse include:
- A job involving lots of heavy weight lifting as in case of laborers or people working in mines with heavy machinery. Lifting heavy weight is one of the most commonly observed causes of intervertebral disc prolapse.
- Jobs that involves a lot of sitting and driving too is one of the commonest causes of intervertebral disc prolapse. Prolonged sitting causes increased pressure on the spinal column and lack of activity can weaken the supporting muscles.
- Certain sports usually increase the risk of injuries, which can be the cause of intervertebral disc prolapse. People involved in sports like running or diving, heavy weight lifting, football, cricket, hockey, boxing or wrestling may be at an increased risk.
- Smoking increases the chances of bone desorption hence causing demineralization of the bones and weaknesses. People engaged in long term smoking can be at great risk of intervertebral disc prolapse.
- Obesity can induce a lot of bodily pressure on the spine and can be one of the contributing causes of intervertebral disc prolapse.
- Elderly people are more prone to these injuries as they are more prone to bone weakening with age. Aging causes degeneration of joints and also weakens the muscles, which can add to the causes of intervertebral disc prolapse.
- Trauma is one of the most important causes of intervertebral disc prolapse as this may cause dislocation of the vertebra and may induce injury to the spine causing pain and gait changes.
- Incorrect body posture or sudden jerk while bending forward in some cases may cause intervertebral disc prolapse.
Symptoms of Intervertebral Disk Prolapse
Here are the commonest symptoms of intervertebral disc prolapse, experienced by most people.
- Back Pain – The back pain can be sudden in onset or gradual, depending upon the pathology and the cause of intervertebral disc prolapse.1 It usually aggravates on coughing, sneezing or bending or being in a certain posture. It usually radiates to the lower back and to the middle portion. The pain can be relieved by medication or physiotherapy.
- Nerve Root Pain (Sciatica) – The sciatic nerve is the longest nerve of the lower limb. Pain is usually caused due to compression of the sciatic nerve in the spinal region.2 It may occur due to a local swelling or inflammation but the main cause being compression of the sciatic nerve due to herniation. The bulging or herniated disc causes irritation of the spinal nerves. This is one of the most important symptoms of intervertebral disc prolapse. Pain in sciatica is usually felt down the leg to the calf or foot. It can range from mild to severe in intensity and can cause discomfort to the patient even when at rest.
- Other Nervous Symptoms – Pressure on the nerves near the site of injury can cause associated symptoms and lead to numbness, loss of reflexes and pain in the nearby areas. In extremely rare scenarios it can lead to paralysis.
Abnormal Bowel and Bladder Movements as there occurs an increase in the urgency and frequency of micturition. Lack of bowel and bladder control is one of the serious symptoms of intervertebral disc prolapse and needs immediate attention.
Other symptoms include altered sensation and patchy numbness in the areas of the affected side. Symptoms like weakness in lower limbs and calf also need to be attended with care.
While these are the commonest symptoms, some patients remain asymptomatic throughout. The patient doesn’t get diagnosed until and unless the dislocation has progressed severely.
Diagnosis of Intervertebral Disk Prolapse
Diagnosis of intervertebral disc prolapse can be done with the help of various examination tests and technical tests. Following are a few examples:
- CT scans can be done to reveal significant disc prolapse. However, CT scans are often not the most reliable tests for the perfect diagnosis.
- An MRI scan is the most accurate test and can be done easily, however, small prolapses may be missed.
- Other investigations include a CT myelogram where dye is injected into the spinal canal and a CT scan is performed, and a nerve sheath injection with a local anesthetic to confirm exactly which nerve is generating your symptoms.
Treatment of Intervertebral Disk Prolapse
Treatment of intervertebral disc prolapse includes rest, application of ice packs in the initial phases. Medications to relieve inflammation or swelling and muscle relaxants are usually prescribed. Physical therapy and exercises help regain the strength and offer effective rehabilitation. In some severe cases, surgical treatment may be required.
Prevention of Intervertebral Disk Prolapse
Prevention of intervertebral disc prolapse needs proper training about the right posture, strengthening exercises and tips for protecting against injuries.
- People should be educated regarding the amount of weight that should be lifted and not to stress a person’s body beyond its limit. The lifting of heavy weights can cause pelvic intervertebral disc prolapse by shifting of the disc due to tension and force generated in other or unwanted direction.
- Exercises to enhance the back strength may also be used to prevent back injuries. Back exercises that are beneficial include- the prone press-ups, upper back extension and pelvic floor bridging exercises to help in strengthening of back muscles. It also relieves any back pain but if pain aggregates then the exercises should be immediately stopped.
- Swimming is a common tool used in strength training especially of the back and pelvic muscles. Swimming and aqua exercises are a great way for prevention of intervertebral disc prolapse.
- The usage of lumbosacral support belts helps to provide better support and relaxation to pelvic muscles.