Treating a Prolapsed Intervertebral Disc
Introduction
The intervertebral discs are the cushions or shock absorbers that are found between each of the vertebrae. They are made up of fibrous connective tissues that protect a soft, gel-like centre. These discs work together with the facet joints to provide stability and flexibility to the spine. However, these discs are susceptible to damage, whether it is from the strain of lifting something too heavy or due to the degeneration that comes with age. When the discs are damaged, they can bulge out of place. If the tough, outer core of the disc ruptures, the soft inner centre of the disc and bulge out. This is called a prolapsed intervertebral disc.
Treatment
In many cases, a prolapsed intervertebral disc will sort itself out on its own with rest and medication. Often, non-steroidal anti-inflammatory medication such as over the counter paracetemol or ibuprofen can help relieve the pain and start the healing process or a doctor may prescribe a stronger dose if warranted. While it may take a few weeks for the back to fully return to normal, the worst pain should subside within a few days and patients should be able to return to most of their daily activities rather soon after an injury or the first complaint. Patients shouldn’t need to rest more than two days before starting to get back to their regular schedules, although a week or two may need to pass before sport can be taken back up.
For those cases that do not start to improve in the days following the first complaint, more aggressive treatments may be necessary. One common form of treatment is an epidural injection. These injections are made very close to the damaged disc and are guided by a live x-ray procedure called fluoroscopy. A solution of local anaesthetic and a steroid solution are injected which wash over the disc. The aim is to numb the area and stop pain signals from being sent to the brain so that the patient can get some relief as well as get anti-inflammatory medicine directly to the disc so that it can have a better chance to heal. Not only can the pain be relieved for several months, but many patients will not need to repeat the procedure as the disc will have healed itself during this time.
If these injections do not solve the problem, more invasive techniques are available. A discectomy is a surgical procedure that aims to remove the parts of the disc that are bulging through the connective tissues and putting pressure on other elements of the spine. Recently a minimally invasive surgical technique has been developed in order to reduce the recovery time for this procedure. In the worst cases, some patients may be candidates for a disc replacement surgery, in which the damaged disc is removed and an artificial disc is inserted in its place.
