Prolapsed Disc

Question 1

What is it

Answer 1

• Nucleus pulposus (inside soft bit) herniates through annulus fibrosis (fibrous outer ring)
• Causes compression of spinal cord + nerves
• -> back pain

Question 2

How common is it

Answer 2

Less than 1 in 20 cases of acute back pain

Question 3

Who gets it

Answer 3

30-50years

M>F (2:1)

Question 4

What causes it

Answer 4

• Sneezing

- Lifting heavy items

Question 5

What are some risk factors

Answer 5

• Obesity
• Jobs involving sitting (driving) or lifting
• Weight-bearing sports

Question 6

What are the symptoms

Answer 6

• Asymptomatic (only some)
• BACK PAIN –> severe + sudden –> eased by lying flat + worsened by movement, cough, sneeze
• Pins + needles/ weakness

Question 7

What are the signs

Answer 7

• SCIATICA - shooting pain in back, down leg, calf + foot, burning, tingling

RARELY –> cauda equina syndrome –> pain + poor bowel/bladder function, saddle numbness, weakness in legs

Question 8

What are some DDx

Answer 8

• Cauda equina

- Mechanical back pain

Question 9

What investigations do you perform

Answer 9

• Clinical Dx

- X-ray, MRI is symptoms persist

Question 10

What is the treatment of prolapse disc

Answer 10

• Exercise + continue activities
  ANALGESIA
• Paracetamol - regularly, full strength
• NSAIDS - ibuprofen, diclofenac, naproxen (caution HTN, asthma, HF, kidney failure)
• Codeine - in addition to paracetamol (NSAIDs don’t work) –> SE: constipation
• Diazepam - muscle relxant - for few days in acute exacerbations
• Physiotherapy
• Surgery - if symptoms not resolved + 6weeks