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Jen
05-01-2013, 06:49 AM
A comment on the medical terminology used to describe what is commonly known as a "slipped" disc.

The terminology for the condition is confusing.

The terms slipped disc, bulging disc, herniated disc and protruding disc are more or less used synonymously, that is, the terminology is interchangeable.

First of all it, is important to appreciate that the primary change in the intervertebral disc is what is known as degeneration, that is, a breakdown of the tissue structure with loss of mechanical properties. It has no direct relation to the aetiology of the common forms of scoliosis or kyphosis (Scheuermann’s disease). The Dr Scoliosis on duty has always preferred to use the term protruding disc. The contents of the disc space cannot protrude backwards unless the circumferential ring of strong fibrous tissue, known as the annulus fibrosus, is weakened or ruptured.

With the advent of MRI technology it has become practical to delineate the exact pathology when a protruding disc is imaged.

It is to be acknowledged that there is no precise correlation between the MRI images of a patient with back pain and the clinical state of the patient. A careful assessment of a patient's pain, and particularly leg pain, is the most important factor in management. Put another way, a doctor's assessment of a patient's problem is far more important in reaching the correct decision on management than any form of scan.

Dr Scoliosis

Dr. Scoliosis, can you tell us what is the usual treatment, apart from pain meds, for a ruptured disc?

Dr Scoliosis
09-01-2013, 10:39 AM
The management of an intervertebral disc protrusion, like all other medical conditions, is based on knowledge of the natural history of the disorder. That is, what happens if no measures are instituted. For example, if one is struck down by influenza, which is caused by a virus, although the patient may feel awful there is no specific treatment apart from avoiding complications and so the disorder runs its course of about four or five days and the patient gets better. Hence, the usual advice given to patients with acute influenza is to go home and go to bed until you get better. On the other hand, if the doctor thinks the patient has acute appendicitis then surgery as soon as practical is usually advised because the natural history for the condition is that the appendix will rupture, peritonitis may take place and this can be fatal.

The natural history of disc protrusion, which has a maximal age incidence in the 20-40 year age group, is to gradually recover from the acute attack which may last up to 6-8 weeks. According to the position of the protrusion one of the nerves passing into the lower limb may be affected and this is the cause of leg pain with or without pins and needles. Rarely is loss of neurological function (weakness) an indication for early surgery.

The principal indication to intervene, that is, to perform surgery, is for severe leg pain which is well relieved by removal of the protruding part of the disc.

If the patient elects to put up with the leg pain this will settle along the lines of the natural history described. Once the acute phase has settled, management is along general lines of improving health and fitness with weight reduction. Most important is developing the strength of the abdominal wall musculature, which is commonly called core musculature, and to use these units in protecting the spine in all activities.

Reputable, long-term studies show that with patients who have bona fide disc protrusions have a comparable functional result after an episode of acute back and leg pain five and ten years post-incident whether or not surgery is employed.

The management of intervertebral disc disorder culminating in protrusion is a very extensive topic but I trust these few remarks are helpful to you.

Dr Scoliosis

Jen
16-01-2013, 09:24 AM
Yes, they are, thank you very much!