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Slipped disc

SLIPPED DISC

Diagnosis: SLIPPED DISC
(PROLAPSUS DISCI INTERVERTEBRALIS LUMBALIS)

Anatomy:
The back is constructed of box-like vertebrae which are held in place partly with the help of the shape of the bones, partly by ligaments and partly by the large and small back and stomach muscles. Cartilage discs (disci) are located between the vertebrae which act as shock absorbers. The discs lie close to the spinal canal from where nerves depart to the legs.




  1. Ligamentum longitudinale posterius

  2. Foramen intervertebrale

  3. Ligamentum flavum

  4. Ligamentum interspinale

  5. Processus spinosus

  6. Ligamentum supraspinale

  7. Corpus vertebrae

  8. Ligamentum longitudinale anterius

  9. Discus intervertebralis

  10. Nucleus pulposus

BACK VERTEBRAE

(Photo)

Cause: If the back is subjected to a load which exceeds its capabilities, a crack in one of the discs may occur so that the liquid content in the centre of the disc (nucleus pulposus) can be squeezed out and apply pressure on a nerve root.

Symptoms: Pain and stiffness in the lower back (lumbago), radiating to one of the legs. There can be sensory interference and reduction in strength of the leg. Symptoms are often aggravated by coughing. In rare cases the nerves can be so severely compressed that problems can arise in control of bladder and bowels, requiring acute surgical treatment.

Examination: If a slipped disc is suspected medical attention should be sought at once to establish the diagnosis and which treatment should be initiated.

Treatment: If examination reveals signs of a slipped disc without alarming symptoms (problems in control of bladder and bowels or substantial deterioration of muscle/paralysis), treatment will primarily be directed at altering the imbalance between the load the back is subjected to, opposed to the level the back is trained to manage. It is therefore recommended that you are instructed (possibly by a physiotherapist) in the appropriate way to put a strain on the back, and which loads and movements should be avoided ("ergonomic guidance"). A few days' rest and relief may be needed to subdue the pain, after which steadily increasing training should be started with back and stomach stabilising and strengthening exercises. If painkillers are required, paracetamol can be recommended, possibly combined with rheumatic medicine (NSAID). Chronic back pain may suggest stronger painkillers, however, stronger medicine should be used with extreme caution as it can quickly lose its effect and there is a risk of increased dependence on the medicine. By far the majority of slipped discs can be managed through correct training (article 1). In cases where the above treatment does not produce progress in the condition, a CT or MRI scan will be considered with a view to possible operation. CT and MRI scan and operation is therefore first considered if the rehabilitation programme does not succeed (article 2). In cases with alarming symptoms (problems in control of bladder and bowels or substantial deterioration of muscle/paralysis) acute hospitalisation is recommended for evaluation of the need for acute surgery.

Special: Training should be performed on a "lifelong" basis to reduce the risk of relapse after a successful rehabilitation. Smoking causes increased risk of lumbago by reducing the flow of blood to the cartilage discs (disci), implying that daily small injuries do not heal so well. Stopping smoking is therefore an important part of the treatment. Shock absorbing shoes or insoles will reduce the load on the back.
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