Prolapsed disc

Question 1

What causes it?

Answer 1

Normally a strenuous activity

Question 2

How does it present?

Answer 2

Acute back pain (lumbago) with or without radiation to the areas supplied by the sciatic nerve (sciatica). May or may not include parasthesia in the affected area.

Sudden onset of severe back pain, often following a strenuous activity.

The pain is often clearly related to position and is aggravated by movement.

Muscle spasm leads to sideways tilt when standing. The radiation of the pain and the clinical findings depend on the disc affected, the lowest 3 being the most common.

Question 3

Investigations

Answer 3

Are of very limited value in acute disc disease and X-rays are often normal. MRI is usually reserved for patients in whom surgery is being considered.

Question 4

Treatment

Answer 4

Acutely: bed rest with sufficient analgesia
7-14 days: slow mobilising (physio)
Surgery only in severe disease or for neurological impairment

Question 5

Conditions that would present similarly

Answer 5

Spondylolisthesis
spinal stenosis
ankylosing spondylitis
arthritis
pregnancy
muscle spasm and chronic disc disease.