Slipped disc

Protrusion of the soft inner core of a vertebral disc, trapping one or more nerves of the spinal column, usually occurring in adults, and often caused by an awkward move when lifting. The condition is also known as a prolapsed or herniated disc. A slipped disc is usually in the lumbar region of the spinal column, and symptoms occur suddenly or in a few days in the form of increasing low back pain (lumbago), and above all pain radiating to buttocks and legs (sciatica), with tingling and possible loss of feeling. A characteristic feature is that pain increases with pressure in the abdominal cavity: with coughing, sneezing or pressure. Discomfort is least acute in the morning; minor reductions in intensity of pain may be noticed, particularly when walking on the toes or heels. Problems with urination or defecation are rare. A slipped cervical disc in the neck is far less common, and causes corresponding pain in one arm. Physical examination shows that pulling or pressing the nerve causes radiating pain. The pain prevents the patient from stretching and raising the affected leg, and often the leg shows reflex disorders ; depending on the position of the slipped disc, the knee tendon or Achilles tendon reflex may be weakened. The slipped disc can be made visible by contrast X-ray examination of the spinal column (myelography), and possibly a CAT scan. Other causes of the pain such as a displaced vertebra, arthrosis or a tumour must be excluded. Treatment in the first place is by bed rest lying on the back for 1 to 2 weeks, using painkillers, muscular relaxants and possibly tranquillizers. The disc returns to its normal shape, and symptoms are reduced. If there are problems with urination or loss of feeling in the buttocks an emergency operation is necessary, because the signs are that a nerve has become severely trapped. A recent development is treatment by injection into the affected disc, which is then dissolved by enzymes, and the protuberance disappears, but it is not yet certain that this method is totally problem-free.

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