Slipped disc.

When discs are out of position.

A 'slipped disc' can be taken at face value. This however means a lot of patients are misled: This is because a 'slipped disc' does not describe an „occurrence“, i.e. an event. No, a 'slipped disc' means primarily that in visual terms the disc has a prolapsed appearance. I.e. it is pushed outwards. It protrudes – and therefore as a consequence may possibly also gets damaged.

Discs are the spine's shock absorbers. They feel like a wine gum or a squid ring: soft and elastic. Externally they have a firm skin but inside they are composed of a gel or jelly-like, viscous mass and a cell nucleus.

 

The loss of elasticity makes the disc protrude.

When a 'slipped disc' occurs there is disc protrusion, which can press on the nerve canal.

When a 'slipped disc' occurs there is disc protrusion, which can press on the nerve canal.

Because of their structure, discs are extremely flexible, cushioning impacts in the spine and ensuring that the individual vertebrae do not rub against each other – because this causes severe pain.

A healthy and young disc is elastic and springs back into shape from every distortion. But over time the disc loses water and forfeits its elasticity. With impacts it is pressed flat and remains in this altered shape. Since the firm external skin has a weak area close to the vertebral canal, the jelly-like contents frequently shifts in the direction of the spinal canal. The disc therefore bulges outwards. If this 'bulge' presses on the nerves which are located in the spinal canal, this produces pain, feelings of numbness and symptoms of paralysis – the classic 'slipped disc'.

 

Definition. What is a slipped disc?

What is meant by a slipped disc?

A slipped is the consequence of damage to an intervertebral disc. And damage to the disc comes from age-related wear and tear which can be accelerated by overexertion or abnormal postures of the spine. If a part of the disc, because it is damaged, bulges in the direction of the spinal canal or the disc even ruptures, then its content escapes into the spinal canal. In both cases this is called a 'slipped disc'. The disc protrudes forwards or backwards &ndash, usually in the direction of the spinal canal towards where the spinal nerves run.

 

Anatomy of the intervertebral disc.

The disc consists of a viscous nucleus and a firm fibrous ring ('annulus'). The most frequent point of rupture is where the spinal cord and spinal nerves run.

The disc consists of a viscous nucleus and a firm fibrous ring ('annulus'). The most frequent point of rupture is where the spinal cord and spinal nerves run.

Discs are the spine's shock absorbers. They consist of a firm outer layer which is filled with a jelly-like viscous contents and a firm nucleus. The outer layer is like an onion and consists of several fibrous layers. Therefore it is called a ;'fibrous ring';. An anterior and posterior longitudinal ligament borders on the fibrous ring. The longitudinal ligament separates the intervertebral disc from the spinal canal.

The older we become the more discs continue to lose fluid forfeiting elasticity and flexibility – similar to a sponge drying out in the sun. A moist sponge is flexible and always returns to its original shape. A dry sponge is brittle, non-elastic and when pressed retains its shape.

Therefore discs too when they have less water content and are pressed more forcefully together – are no longer able to return to their original shape. Overall they lose height.

 

From damage to intervertebral discs to a slipped disc.

If the disc dries out slowly the fibrous ring develops fissures. These develop primarily in the area adjoining the spinal canal through which the nerve paths run in the vertebral column. Parts of the soft, jelly-like contents of the disc may escape into these fissures of the fibrous ring. The disc slowly changes shape and bulges in the direction of the spinal canal. This status is the precursor to a slipped disc.

If the external skin ruptures completely because of the resultant pressure, a hole develops in the fibrous ring. The the jelly-like contents and even possibly the firm nucleus escape into the spinal canal. This can cause the nerves in the spinal canal to become compressed. In this case patients complain about symptoms of paralysis. Then a doctor must be consulted immediately.

 

Different types of slipped discs.

Different forms of slipped disc can be distinguished:

  • Bulging disc (med.: Intervertebral disc protrusion): The disc bulges but the fibrous ring remains intact
  • Slipped disc (med.: Prolapsed disc): Disc tissue escapes through the fibrous ring
  • separated slipped disc (med.: sequestered prolapsed disc): Disc tissue breaks through the longitudinal ligament and escapes through the fibrous ring into the spinal canal
  • separated slipped disc with release of a fragment (med.: subligamentous prolapsed disc with sequestration): The disc ruptures the posterior longitudinal ligament. Fragments of tissue break away and escape into the spinal canal.
 

The most frequent type of slipped disc.

Slipped discs are diagnosed most frequently – around 80-85% in the lumbar spine region. This is where the spine is put under the most stress. The cervical spine therefore which only has to bear 5 to 6 kilos accounts for only 10-15% of all slipped discs. The least common type of slipped discs are those in the thoracic spine. Here, the thoracic spine is stabilised by the rib cage and barely moves.

 

Symptoms. What are the signs of a slipped disc?

Radiating back pain. Symptoms of a slipped disc

If the discs in your back slip, your back will hurt. Pain can spread from your lower back into your legs.

If the discs in your back slip, your back will hurt. Pain can spread from your lower back into your legs.

Back pain – most patients with slipped discs come to us with this explicit symptom. Every slipped disc is associated with pain in the back and/or pain that spreads to other parts of the body. Frequently sensory disturbances or paralysis occur in the legs and feet. Depending on the area of the spine affected back pain can be located in the neck or lower back. The thoracic spine region is seldom affected.

 

The pain can radiate into arms and legs.

Symptoms of a slipped disc in the lumbar spine.

The main symptoms of a slipped disc in the lumbar spine are pain in the lower back. This can travel into one or both legs and subside when the leg is bent. Usually a patient with a slipped disc in the lumbar spine can barely raise his/her leg when it is extended, because this movement increases the pain. The same applies for coughing, sneezing and compression.

Symptoms of a slipped disc in the cervical spine.

A symptom of a slipped disc in the cervical spine is neck pain. This can occur on one side or on both. Frequently it travels into the shoulder or between the shoulder blades. Here hardening of the muscles can develop which really need to be protected from forceful movements which will trigger pain. Patients with a slipped disc in the cervical spine also frequently complain about headaches and dizziness.

Warning symptoms: Paralysis and numbness.

If the nerves in the spinal canal of the vertebral column are strongly compressed or have been been damaged extensively, the sensation of pain is less. At the same time distinct areas in the arms and legs can be affected by feelings of numbness. Therefore subsiding pain with progressive paralysis are an alarm signal: The pain-conducting fibres of the disc are then already destroyed. If there is central stenosis of the vertebral canal then disturbances in gait or even paraplegia may occur.

You should then immediately consult a doctor if you have feelings of numbness or symptoms of paralysis. This includes disturbances in the urge to urinate or defaecate.

 

Causes. How a slipped disc develops

What factors lead to a slipped disc?

A slipped disc develops from long years of damage to the intervertebral discs. Such damage to intervertebral discs is a phenomenon of wear and tear. Like everything that is used on a daily basis, over time there are signs of overuse. Wear and tear can however be accelerated by one-sided weight-bearing or a weakness in the body's musculature. Damage to intervertebral discs is a genetically pre-programmed condition and generally runs in the family.

 

Overload, lack of exercise, weak muscles.

Wear on the discs are the cause of a herniated disc. Poor posture and overuse can promote wear.

Wear on the discs are the cause of a herniated disc. Poor posture and overuse can promote wear.

Lack of exercise, poor posture, heavy load or overweight are unfavorable factors. Truck drivers or construction workers use their back, for example, particularly strong and often take a stooped posture and thus a wrong attitude. If heavy objects are lifted incorrectly, an acute herniated disc can be triggered. Another reason for a herniated disc are also weak back muscles, because strong muscles relieve the spine and help to prevent incorrect loading of the intervertebral discs. Occasionally, a herniated disc also develops during pregnancy.

Most frequently, herniated discs occur in the lumbar spine. 800,000 herniations are diagnosed each year in Germany. The average age of the patients is between 45 and 55 years.

 

Diagnostics & Therapy

Often medication and physiotherapy can alleviate pain. Without improvement an endoscopic operation could be an option.

Detection & Therapy of slipped disc

 

Treatment success & quality

Less pain, more quality of life: 81% of patients can return to work 3 months after the treatment of a slipped disc.

Treatment quality

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