Also called herniated disc or PID –prolapsed intervertebral disc. Your body has a disc which is a cushioning structure between the 2 bones or vertebrae in the spine. This disc has 2 layers,an outer one called the annulus (thick fibrous) and an inner nucleus( jelly like) material. Due to wear and tear or wrong and prolonged sitting, this disc undergoes fatigue and tears causing the nucleus to come out and cause pressure on the nerves behind. This is very much like a cushion tearing and the cotton coming out. Usually the last 2 discs in the body, which is the lumbar 4-5 or 5-1 tear.

»  Does everybody with back pain have a slipped disc?

No. Though slipped disc is an extremely common condition, it is often over diagnosed. Most people with back pain of sudden onset who get better in 2-5 days may just have muscle, ligament or facet joint associated pains. Also the pain may be from a torn disc and not slipped disc.

»  What is the difference between a torn disc and slipped disc?

It is different in that say for example your pillow, if it tears it is a torn disc but if it tears and cotton comes out it is a slipped disc and the material that comes out causes pressure on the nerves. So the pain from a torn disc is usually only back pain whereas from a slipped disc it is back and leg pain.

»  What are the symptoms of a slipped disc?

It may start after lifting something heavy or by itself. Usually it starts off with back pain  which may be followed by leg pain which goes down the buttock to the calf and even foot. This is an acute disc. Usually by the time the leg pain starts the back pain decreases. Some people have a slow onset pain described as a chronic disc.

»  What is the treatment for a slipped disc?

All back pains with severe spasm and leg pain should be treated with complete bed rest. Usually the pain gets better in 3-5 days by at least 60-80 percent. 75 percent of people with slipped disc get better by themselves. After the intensity of the pain reduces we usually begin a program of physiotherapy. No exercises are done in the acute painful stage. Medicines are usually just painkillers, muscle relaxants and nerve medications.

»  When does a person need surgery?

3 indications

• Pain not getting better after adequate rest—usually after 4-6 weeks (of initial episode and after physical therapy) if you are not feeling better you are unlikely to improve
• Patients coming with severe weakness and numbness—the doctors indication for surgery.
• Patients with loss of bladder and bowel function—emergency—this is a rare presentation.

»  What about epidural steroids injections?

In a slipped disc condition epidurals are used with the idea that they will relieve the symptoms till the patient has a chance of getting better. This means that if you have a chance of improving by yourself then the epidural keeps you comfortable till that happens. The epidural cannot push the disc back.

»  What is ozone therapy?

Ozone is a gas, which has anti-inflammatory properties. It works like epidurals to relive pain. It is not useful for other conditions and there is no scientific data to support its use.

»  What about acupuncture/acupressure?

They are just pain relieving modalities. By pressing the leg you cannot push the disc back. What these modalities do is confuse the brain (where pain is felt) by giving a pressure stimulus. If you have to get better then it keeps you comfortable till that happens. Do it to feel better and as long as you don’t twist and manipulate your back it is safe.

»  What about heat bags and massage?

Also pain relieving modalities and not cure. No harm as long as excessive pressure is not applied during massages.

»  So if I do need surgery what does surgery involve?

Based on your history, examination and timing of presentation (days of having pain and pattern of pain) your doctors will decide if you need surgery or not. If your leg pain is more than back pain then you will definitely benefit from surgery. Surgery involves removal of the pieces/pieces of disc that have escaped from the main disc. The entire disc is not removed. This can be removed by microscopic lumbar discectomy or endoscopic discectomy. Both are recognized procedures with a small cut in your back in which the patient stays in the hospital for just about 4 days on an average.

»  What happens in surgery?

Under general anaesthesia a small cut is made in your back. This measures in an average about one to one and a half inches. The disc tissue is then dissected out. The average time for this procedure is about 1-1.5 hours. Usually this is a risk free surgery with hardly any chance of nerve damage nowadays.

»  What happens after surgery?

You are kept in the recovery room for about 1-2 hours and then shifted back into your room unless you have associated medical problems, which may require intensive care. You are made to lie on your back and can turn in any direction you want. You do not sleep on your stomach after surgery. The next evening you are made to stand and walk. A urinary catheter (for passing urine) is passed so that you are comfortable in the post- operative period. This is generally removed after 2 days when you are comfortable enough to use the bathroom You are made to walk in the hospital corridors, climb stairs and use a commode before discharge.

»  What exercises do I do after surgery?

This is the best part. You do not need exercises for the 1st 6 weeks after surgery just a few leg exercises that will be taught to you in the hospital. You do not need a physiotherapist at home. Exercises are taught after 6 weeks of surgery to strengthen the back.

»  When are the stitches removed and when can I take a bath?

Usually removed after 14days in my office. You can take a bath after the stitches are removed. Till then, sponging is recommended.

»  What can I do and cant I do after surgery?

You can stand, walk and sit on a chair with a gradual increase in time. You should not bend, sit on the floor or lift objects more than 4-5 kgs and avoid long distance travel for about 6 weeks after surgery. You can resume office work after 2 weeks if you have a desk job. Initially half day of work and then gradually full day. You wear a soft belt for 6 weeks after surgery. Remove if after that or you get psychologically dependent on it. If you have a heavy job then it is better to resume after one month. This is because the internal healing takes about that much time.

»  Why is it that I have heard that disc surgeries are never successful?

As with any surgery this surgery too can have its complications. But with modern technology, the intra-operative risks have been drastically reduced (less than 1%). There is however a chance or recurrence of the herniation (5-10%). What one must understand is that disc surgery is reparative work done on a damaged disc. We cannot correct the bad disc so there are chances you may injure the same disc in future or another disc in your spine. This is not an appendix surgery where once the appendix is removed it will not give you any problems. This is like a bypass surgery. Once done you can always get a heart attack but you take adequate are to prevent one by exercising. Similarly with proper back care and exercises you stand to reduce this risk to the minimum.

The views expressed in this article are the views of the author only based on scientific facts and experience. They may vary from person to person.