By Dr. Tan Boon Cheong
MBBS (MU), MS Ortho (MU)
Long hours of sitting in front of computer on your desk. Lack of exercise due to busy schedule. Then one fine day, you decided to bend forward to pick up something from the floor or you decided to lift some heavy stuff. As you get up from the position, you suddenly feel an intense pain on your lower back which sometimes radiated down to one or both your lower limbs. This is one of the many scenerios for someone who may experience troubled disc .
Not all this back pain is due to prolapsed intervertebral disc (slip disc). Most of the time, this pain is due to a sudden cramp of the lower back muscles. But if the pain is radiating in nature then the likelihood of slip disc will be higher. Sometimes, this pain may be associated with a numbness on parts of the lower limb. In worse cases, this pain may be accompanied by weakness of the lower limbs, urinary and bowel incontinence.
A consultation with an orthopaedic or spine surgeon is necessary. A good history and clinical examination is good enough to decide if this is a possible disc prolapse. A simple plain X-ray may not be enough to confirm the diagnosis of prolapsed disc. Thus a MRI of the lumbar spine will give a better picture to confirm the diagnosis, the level involve ( usually L4/L5 or L5/S1), the severity of the prolapsed disc and nerve compression.
Not all prolapsed disc need to go under the knife, unless there is neurological deficit as mentioned above. Most of the time, conservative treatment with medication, ice compression, proper resting and physiotherapy or chirotherapy will do the job. Good back care is a must as part of the treatment and also prevention of recurrence. Surgical intervention such as epiduralysis and nerve root injection for pain management or open surgery namely discectomy ( to remove the herniated disc) will be needed if conservative management fail.