Slipped disc. Diagnostics & Therapy
How is a slipped disc identified?
At the start of the diagnosis a thorough neurological examination is carried out by our doctors which can detect paralyses, feelings of numbness and differences in reflex response. An x-ray of the cervical spine or lumbar spine gives an idea of the bone structure. The most important examination procedure however is the MRI.
No exposure to radiation is involved and it offers, in contrast to a CT, significantly more information in terms of size, extent and shape of the slipped disc, and information about the affected nerves.
Exact diagnosis through magnetic resonance imaging.
The tomographic images of the MRI allows an exact statement regarding the state of wear to the disc and the vertebral joints. MRI images allows evaluation of the vertebral canal and the nerve channels. Reliable evidence can be provided for a slipped disc and also statements about the degree of severity of the prolapse/herniation is possible.
Nowadays therefore, magnetic resonance imaging (MRI) makes an exact diagnosis possible in virtually 100 percent of cases (disc wear and tear, disc herniation/slipped disc or narrowing of the spinal canal, etc.) and also makes it possible to rule out less common but serious illnesses such as tumours or inflammation. Occasionally, computed tomography (CT) is helpful, particularly when bone changes needed to be examined or when a very recent slipped disc needs to be ruled out.
What therapies are available for a slipped disc?
In the first instance we treat painful damaged intervertebral discs in the Schön Klinik hospitals by conservative methods – i.e. without surgery. A combination of immobilisation and pain-relieving medicines is successful in over 85% of cases.
In the case of a slipped disc in the cervical spine for instance the spine is immobilised for 24 to 48 hours with the help of a soft neck collar – in an acute stage this has a pain-relieving action.
Pain therapy and osteopathy.
Pain relievers and muscle relaxants can be used to support the therapy. If symptoms are intractable, pain relievers are injected directly into the source of the pain using X-ray or CT guidance (nerve, vertebra, vertebral canal).
Application of heat in the form of mud packs or baths also provides a pleasant sensation. Treatment is supported by low-stress physiotherapy techniques such as osteopathy. Once the pain has subsided, gentle muscle building under the guidance of a physiotherapist is helpful. In this way the spine is stabilised.
Is sports possible in spite of a slipped disc?
If pain from a slipped disc does not hinder sporting activities, then keeping mobile is very sensible – muscles and ligaments become stronger, support the spine and so relieve the discs.
Back crawl is an ideal form of swimming exercise. Likewise types of duration sport such as Nordic Walking, jogging and even cycling - as long as the back is in an upright position. In terms of winter sport cross country skiing is helpful, however if anything in the classic style not the skating style.
In general three sporting activities a week lasting between 40 and 60 minutes is ideal. Longer times are not usually detrimental.
Operation on slipped discs.
It is only if conservative therapies such as massages, gymnastics or treatments involving the application of electrical energy are unsuccessful that an operation will be given consideration.
We only recommend an operation if within 2 to 3 weeks there has been no significant improvement in symptoms and the slipped disc can still be detected by an MRI.
The surgical procedure depends on the size, shape and location of the slipped disc. At the same time we always use minimally invasive procedures – either with the help of a surgical micrsocope (microsurgical) or an endoscope (keyhole surgery).
Then the nerve canal is widened or small disc prolapses removed using small cutaneous incisions at the respective location with the aid of an endoscope (keyhole foraminotomy). Endoscopic procedures however are not an option for every patient.
Very good results after a disc operation.
Slipped disc surgery is the most frequently performed spinal and neurosurgical intervention worldwide. Generally, the results of surgery are very good and, depending on the type of surgery, will also allow the patient to resume sporting activities and other pastimes.
For example, in February 2006, Sylke Otto won the luge competition at the Olympics, six months after having an artificial disc implanted in the Schön Klinik München Harlaching.
The results from surgical and conservative therapy are usually the same after 4 to 10 years. The medium-term and long-term result after an operation is therefore identical the the result without an operation. Experience has told us that usually the results from surgery are achieved more quickly and that a patient can be more rapidly reintegrated into their professional and social environment.
Old for new disc replacement for a slipped disc in the cervical spine.
We operate on most slipped discs in the cervical spine in the Schön Klinik using an anterior approach. The disc can be completely removed via a small incision in the front of the neck. The foramen and/or spinal canal can also be widened via this incision. A method that has proved its worth in terms of enabling these patients to have a pain-free life is replacement disc surgery. The removed disc is then replaced either with an artificial disc or a plastic implant. An artificial disc preserves mobility while a plastic implant will result in the "stiffening" of two vertebrae. However this only restricts mobility a little.