Disc Herniation

Question 1

What is it

Answer 1

The nucleus pulposus bulges or leaks through the annulus fibrous.
Commonly affects lumbar and cervical spine

4 types - disc degeneration, prolapse, extrusion, sequestation

Question 2

Features

Answer 2

Local pain
Radicular pain

Neurological:
numbness or tingling in extremities
Weakness in specific muscles, depending on nerve root affected

Reduced ROM

positive straight leg raise

Severe: caude equina

4 types - disc degeneration, prolapse, extrusion, sequestation

Question 3

Epidemiology

Answer 3

5 - 20 cases per 1000 adults per year
1 - 3% will be affected in their lifetime

Most common:
Lumber L4-L5, L5-S1
Cervical C5-C6, C6-C7

Question 4

Age

Answer 4

30 - 50

Question 5

Risk/ causes

Answer 5

Bio mechanical - heavy lifting, repetitive bending/ twisting
Degenerative Changes
Family genetics
Obesity
Sedentary lifestyle- weak core muscles
Smoking
Trauma

Question 6

Presentation

Answer 6

Acute or chronic onset

Lumbar: low back pain, pain radiating down leg, numbness or weakness in the foot or leg

Cervical: neck pain, pain radiating to shoulder, arm, hand. Numbness or weakness in UEX

Red flags: loss of bladder/ bowel control - cauda equina

Question 7

Prognosis

Answer 7

Natural: can improve with treatment in 6-12 weeks
May reabsorb partially or fully over time

Serious - surgery