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24 August 2011
Back pain is one of the leading reasons Americans seek medical care. Some 80% of Americans will experience back pain during their lifetime; 44 million Americans are estimated to be in treatment today with chronic lower back pain. A common reason for such statistics is prolapsed discs.
Prolapsed discs, often misdiagnosed as the similar conditions — herniated or bulging discs — are caused from back trauma, or regular strain from heavy lifting. Data show some 5% of lower back pain is due to prolapsed discs and is one of the leading causes for back surgery. Herniated and bulging discs are slightly different conditions, even though the three have similar diagnostic and treatment options.
What is a prolapsed disc? Imagine a jelly donut. Each vertebrae in the spine is separated by inter-vertebral discs with a tough outer layer and a gelatinous, liquid center. When the spine is injured, these discs between vertebrae can be injured, causing the inner liquid center to push outward — like squishing a jelly donut. Once the inner liquid of the disc — or nucleus pulposus — has been displaced, there is often pressure on the associated nerve roots. There is only so much room in the spinal canal and not enough to accommodate nucleus pulposus that has been misplaced. As a result, nerve roots are put under pressure that can cause pain, numbness or weakness.
The most common prolapsed discs are found in the lumber, or lower, spine, and the neck — or cervical spine. Rarely are prolapsed discs diagnosed for the thoracic region. A prolapsed disc 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, an emergent condition called Cauda Equina.
To diagnose a prolapsed disc, a pain physician may order one of several imaging tools. A X-ray, CT scan or MRI are commonly used for this condition — not just to better see the inter-vertebral disc, but also to rule out other potential sources of pain, like fractured discs. A nerve conduction study may also be ordered.
Research shows some 90% of patients with low back pain will see improvement with conservative physical therapy. This may include: strengthening, spinal manipulation, ultrasound therapy, brace support, traction and hot/cold therapy.
Lifestyle changes, including weight loss, a healthy diet and regular exercise are also recommended. A pain physician may also recommend:
- Over-the-counter non-steroidal anti-inflammatory medications (NSAIDS)
- Opioid medications
- Epidural steroid injections
Those still in pain after exhausting these treatment options may need surgery to reduce the pressure on the nerve root. The most common procedures for prolapsed disc are: open discectomy, micro-discectomy and endoscopic options.
Prevention of prolapsed discs is possible; pain physicians recommend good posture and proper lifting techniques.
References
- 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 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 www.mdconsult.com.ezproxy2.library.arizona.edu/das/patient
- 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.
