One of the most common health complaints heard by physicians is back pain. A common reason? Prolapsed discs. This is the condition of a vertebral disc pushing outside of its designated space, which typically puts pressure on nearby nerves.
A prolapsed disc can be caused from back trauma, or regular back strain from heavy lifting. Researchers report some 5% of lower back pain is due to prolapsed discs. While a small percentage, this condition is one of the leading causes for back surgery. Other names often associated with prolapsed discs are herniated or bulging discs – even though each condition is slightly different. Diagnosis and treatment of all three are often similar.
Inter-vertebral discs are found between the bones — vertebrae — of the spinal cord. These bones, with discs sandwiched in between, are stacked to form the spinal column. All of these elements work together to protect the spinal cord and promote spinal motion. Inter-vertebral discs are made of a thick layer of tissue called the annulus fibrosus. The inner layer is liquid, called the nucleus pulposus.
When a disc is prolapsed, the inner liquid layer presses against the outer thick tissue layer causing a bulge. This bulge presses on a spinal nerve root, causing pain, numbness or weakness. The most common prolapsed discs are found in the lumbar, or lower, spine. They are also on occasion see in the neck — or cervical — vertebrae. When a disc is prolapsed in the lumber spine, it can cause radiating nerve pain; the pain is actually felt in another area of the body, typically the lower extremities or groin. This can also cause bowel and bladder incontinence, however this is most likely seen in patients with a more advanced form of prolapsed disc called Cauda Equina.
Diagnosis of a prolapsed disc may include: an X-ray to eliminate other causes of pain, such as a fracture; a CT or MRI scan to produce images of the inter-vertebral discs and possibly nerve root compression; or a nerve conduction study.
Research shows some 90% of patients with low back pain will see improvement with conservative physical therapy, in addition to:
- Lifestyle changes, including weight loss, a healthy diet and regular exercise
- Over-the-counter non-steroidal anti-inflammatory medications (NSAIDS) for management of pain
- Opioid medications or muscle relaxants for more severe pain
- Epidural steroid injections
For the 10% of patients who do not respond to these conservative treatment options, surgery may be required to alleviate pressure on the nerve root and ease pain. The most common surgeries in this area are: open discectomy, micro-discectomy and endoscopic options.
To prevent prolapsed discs, patients should practice good posture and use proper lifting techniques to avoid injuries and strains to the lower back.
- Wheeler, S.; et al. (2010). Approach to the diagnosis and evaluation of low back pain in adults. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- eOrthopod. (2009). What’s the difference between a disc prolapse and a disc herniation? eOrthopod. Retrieved from http://www.eorthopod.com/content/whats-the-difference-between-a-disc-prolapse-and-a-disc-herniation
- Fardon, D.; Milette, P. (2001). Nomenclature and Classification of Lumbar Disc Pathology: Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. Vol 26, E93-E113.
- Nidus Information Services. (2010). Herniated Disk. Patient Handouts page. MD Consult Web site, Core Collection. Retreived from http://www.mdconsult.com.ezproxy2.library.arizona.edu/das/patient/body/234155712-5/1108605568/10041/35144.html
- Hsu, P.; et al. (2011) Lumbosacral radiculopathy: Pathophysiology, clinical features and diagnosis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- Raj, P. (2008). Intervertebral Disc: Anatomy-Physiology-Pathophysiology-Treatment. Pain Practice. Vol 8, 18-44.
- Gibson, J. N. A.; Waddell, G. (2007). Surgical Interventions for Lumbar Disc Prolapse. Spine. Vol 32 1735-1747.
- Chou, R. and Huffman, L.H. (2007). Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. Vol 147(7), 492-504.