SCIATICA, SLIPPED DISC

(HERNIATED DISC)

          SCIATICA is a pain that radiates from the back down one or the other leg. Exertion, sneezing, coughing, or straining the back often exacerbates the pain. One of its most common cause is a slipped disc which exerts pressure on one of the roots of the sciatic nerve (the largest nerve of the body), and it can also be triggered by temporary local trapping or straining of the sciatic nerve or its roots. Rarer causes include tumors, bony deposits and infections, which can affect the sciatic nerve throughout its course.

BACKGROUND ON THE DISCS:

          The discs(intervertebral discs) between the vertebral bodies are composed of a connective tissue ring and a pulpy, semi-fluid substance in the middle.

SLIPPED DISC, HOW DOES IT OCCUR?

          Slipped discs often show signs of changes due to age (disc degeneration), which may also occur in a relatively young individual. Cracks form in the connective tissue ring of a disc, allowing the pulpy the substance to seep through and cause pressure on the adjacent roots.

          The most common cause of slipped disc is bending forward with rotation of the spine to the side while lifting heavy objects.

SIGNS and SYMPTOMS:

1. Pain on the lower back that radiates into one leg.
2. There may be numbness in the distribution of the nerve.
3. Weakness in the leg.
4. Pain is triggered by coughing or straining.
5. Pain can be so severe that the lumbar region (lower back) is locked in a position of lateral flexion (side - bending towards the opposite side)
6. Tenderness and tense lower back musculature.

DIAGNOSIS:

1. The diagnosis is confirmed by the history of the pain, which is typical in Sciatica.
2. Mobility of the lower spine is impaired and the lower back musculature is tender and tense.
3. Examination of the spine may reveal a scoliosis caused by a strong muscular contraction in the lower back or due to the patient's position of comfort .
4. Positive Lasegues sign: that is, with the patient lying on his back, with knees straight, the examiner raises the affected leg. At some point the patient experiences pain radiating down the involved leg.
5. Neurological examination of the nervous system reveals diminished reflexes, weakness or paralysis of the muscles supplied by the affected nerve, and impaired sensation.
6. A diagnosis of slipped disc is confirmed by X-ray.

TREATMENT:

          The patient is advised to have:

• Bed rest in the appropriate position (place pillows under the legs with the knees bent at approximately 90⁰)
• Apply local heat and use a heat retainer.

         The doctor may:

• Advise continued bed rest and limitation of activity for 8 - 12 weeks.
• Prescribe analgesics, anti-inflammatory drugs and muscle relaxants.
• Start gentle traction treatment under the supervision of a physical therapist when the condition has passed its acute stage.
• Prescribe TENS (Transcutaneous Electrical Nerve Stimulation)
• Operate when acute pain persists in spite of analgesic drugs or when paralysis occurs. A new procedure involves the injection of an enzyme called chymopapian into the disc. This enzyme dissolves the center (nucleus) of the disc and relieves pressure on the nerve roots.
• In case without urgent complications, frequent re-examinations should be carried out. Before surgery on a slipped disc, X-ray examination is carried out so that the doctor can identify and locate the slipped disc.

HEALING:

1. Most individuals who suffer from a slipped disc recover gradually with rest alone.
2. Hospital treatment after surgery for a slipped disc lasts for 4 - 8 days or longer. During early post - operation, activities of the patient is limited. Not until 3 - 4 months later can a return be made to active heavy work or active sport.
3. Of those who are operated on, 95% make a complete recovery and can return to their original jobs.

D.K. Mangusan Jr., PTRP

Sat Sep 30 1:53:31  2006

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