A friend has been told that she has not just one prolapsed intervertebral cartilage but two and a half (meaning that two have pushed out to form a T but one hasn't yet ). They are at the base of her spine, between some of the last five vertebrae.
How is this treated? Does it require surgical intervention? What procedure is adopted: does the surgeon permanently 'fuse' vertebrae, fix then together, as part of the process ? She has complained that, apart from the pain, she has some loss of movement in her left arm. Could that be related ? [This is not a problem for our National Health Service. My friend has suffered this in Mumbai, India .That's why I'd like to know, though I trust that the doctors there, in private medicine, are capable ) ]
The majority of "Slipped" disks.. or rather, as is more correctly named, "Herniated" disks (about 90%) do not require surgery, and will resolve with non-operative treatment.
Features of conservative treatment typically include:
resting the neck area by maintaining a comfortable posture and painless activity level for period of a few days to several weeks, sometimes using a cervical collar or neck brace using non-steroidal anti-inflammatory medication
an epidural steroid injection may be performed in cases of severe pain, utilizing a spinal needle under x-ray guidance to direct the medication to the exact level of the disk herniation
a physical therapist may develop a course of rehabilitation based on successful modes of treatment, such as traction, ultrasound, electrical muscle stimulation, whirlpool, and so on, proven beneficial to herniated disk patients
Non-steroidal anti-inflammatory medications such as aspirin, acetaminophen or ibuprofen may be recommended to decrease swelling and relieve pain. Sometimes time-released medication is most effective. While other painkillers may be prescribed, narcotic pain medication is generally avoided.
Patients who have a severe episode of pain may benefit from a single treatment of a steroid epidural, injected directly into the affected part of the neck. This form of treatment can often relieve the situation to such a degree that other treatment measures can then be put into place.
Surgical Treatment of Cervical Disk Herniation? Surgical procedures may be considered in the event that conservative therapy does not bring about sufficient pain relief. Surgery should also be considered when there is significant compression of the spinal cord with signs of cord dysfunction or myelopathy as these symptoms and signs may be permanent even after surgical decompression.
Types of Surgery:
Surgical treatment for herniated cervical disks varies according to the severity of the injury.
One method is known as microdiskectomy:
It involves the open removal of the part of the herniated disk that puts pressure on the spinal cord.
Another common surgical method is known as anterior cervical decompression and fusion:
Like microdiskectomy, this is a major operation involving open incision, dissection of muscle and tissue, and possible bone graft procedures. Both operations involve a hospital stay of 3 to 5 days. Many patients may be up walking the same evening or the next morning after surgery. Some discomfort when swallowing, from retracting the esophagus, commonly occurs, but this is usually a mild and transient symptom.
Patients who have sustained one disk herniation are at increased risk statistically for experiencing another. Approximately 5% of the time the herniation recurs at the same level; more rarely, there may be a new disk herniation at another level. Many of the factors involved in disk herniation are related to one’s level of physical conditioning and work or behavioral habits. People who are overweight have an increased risk of disk herniation, as do those who attempt strenuous physical labor (such as moving heavy objects) when they are out of shape.
People who have experienced a herniated disk, whether treated conservatively or with surgery, are advised to become knowledgeable about caring for their backs: using proper lifting techniques, practicing a specific set of stretching and strengthening exercises, and modifying their activities to protect the backbone. All of these measures may significantly reduce the chance of repeated injury to the spine.
Major surgery for cervical disk herniation usually requires a recovery and rehabilitation period of at least 4 to 6 weeks. A spine operation may involve the specialized skills of both an orthopedic surgeon, whose expertise concerns bones and joints, and a neurosurgeon, someone familiar with spinal cord injuries.
A herniated disk occurs when the disk is damaged by a number of situations. Some of the most common causes of a disk injury are:
a fall or accident Repeated straining of your back A sudden strain on the back - from lifting or twisting violently Degeneration due to aging Spontaneous herniation can occur without any specific injury When the disk is damaged, the soft rubbery center of the disk squeezes out through a weak point in the fibrous outter layer, causing a bulge that often presses on nearby nerves.
For so called slipped disc in the lumbar area, the indications for surgery from my point of view are a significant amount pain with straight leg raising that recurs after being relieved with 10 days of bed rest. If it is not relieved or if there is significant attenuation of the DTR’s (Deep Tendon Reflexes) surgery is indicated if test confirm a true herniated disc. For the neck, I would think one should most of the time have arm pain. Our fancy test are now picking up things like so called bulging disc ( no nerve root compression) that are probably best left alone as far as surgery is concerned.
Posts: 45 | Location: Bastrop, La USA | Registered: 02-08-07