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Lumbar Disc Herniation

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Lumbar Disc Herniation is a condition where the disc, which is normally present between two vertebral bones herniates and bulges into the spinal canal or neural foramen or both compressing on the spinal nerves. As we age, the disc becomes weakened or damaged because of wear and tear mechanisms caused by excessive pressure such as heavy lifting. The Lumbar disc herniation generally occurs in the below-mentioned ways-
Degeneration

 the disc becomes weak, thinner, and may shrink (usually occurs with age) but the nucleus does not break through the outer wall of the disc.

Disc prolapses/ herniation

the disc has a bulge that puts pressure on the spinal canal or the nerve.

Extrusion

the nucleus ruptures and comes out through the disc annulus but stays in one piece.

Sequestration

the nucleus ruptures and separates from the main portion of the disc.

Causes of Lumbar Disc Herniation

Causes of slipped disc is a change in the structure of a normal disc. Mostly, disc diseases happen with age and the normal wear and tear of the lumbar disc. Severe injury can cause the normal disc to herniate at a younger age even before degeneration starts.

Symptoms of Lumbar Disc Herniation

The symptoms of lumbar disc herniation disease are different for different people depending on where the disc has herniated and what nerve root it is pushing into. The most common symptoms of Lumbar Disc Herniation are discussed as follows-
  • Intermittent or continuous back pain
  • Spasms of the back muscles
  • Sciatica- An electric shock like or shooting pain radiating down the leg
  • Muscle weakness in the legs
  • Numbness in the leg or foot
  • Decreased reflexes at the knee or the ankle
  • Changes in bladder or bowel functions

These are general symptoms of Lumbar Disc Herniation that can be associated with other problems so when you observe any of these symptoms, Consult a Spine Surgeon in Dubai ( UAE) for a diagnosis and appropriate management

Diagnosis of Lumbar Disc Herniation

Most back pains can be treated medically with painkillers and physiotherapy. There’re some red flags like weakness of legs, bladder disturbances etc., which warrants additional investigations. Though a herniated disc can only be confirmed by the MRI, a good clinical examination is must to determine whether the symptoms are correlating with the imaging findings. Hence a complete evaluation of the medical history is done along with a thorough physical examination. Sometimes additional tests may be required which are
  • X-ray Lumbosacral spine
  • MRI (Magnetic resonance imaging) which uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of the Spinal bone, joints, disc and nerves.
  • Myelogram- which is very rarely used nowadays after the invention of MRI. The patients who cannot undergo MRI because of any implanted cardiac pacemaker or similar devices need myelogram for further evaluation. It involves injection a radio-opaque dye into the spinal canal to make the structures visible on the X-rays.
  • CT scan or CAT scan (computed tomography scan)- more detailed than general X-rays. A CT scan shows detailed images of the spinal bones and joints.
  • Nerve conduction study and Electromyography (EMG)- are required in doubtful cases when the imaging findings does not correlate with the clinical symptoms. It measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle.

Treatment of Lumbar disc herniation

Conservative therapy is the first line of herniated disc treatment for treating Lumbar disc herniation which may include the following-
  • Bed rest
  • Education on proper body mechanics (to help decrease the chances of worsening pain or damage to the disc)
  • Physical therapy, includes ultrasound, massage, conditioning, and exercise programs
  • Weight control  
  • Use of a lumbosacral back support
  • Medicine to control pain and relax muscles

If any of the above-mentioned measures doesn’t work then you have to consult a Best Neurosurgeon in Dubai to discuss further options available which may include slipped disc surgery to remove the herniated disc. If disc herniated surgery is required your Neurosurgeon with discuss in detail about the spine surgery which can be done in many different ways. After disc herniated surgery, you have to restrict strenuous physical activities for around 2 weeks and physical therapy can be started after 10 days from surgery to strengthen your back muscles. If you have been advised surgery and you are not sure whether to go ahead or not, please feel free to get a second opinion with another neurosurgeon.

Dr. Arun Rajeswaran

Consult Dr. Arun with a professional experience of more than 13 years in the field of Neurosurgery

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