Prolapsed disc Flashcards
Which part of the spine is most commonly affected?
Lumbar spine.
What is a disc?
A soft cushion of tissue between the bones in the spine pushes out.
When might a prolapsed disc become painful?
If it presses on nerves.
Define a prolapsed disc.
A progression of disc degeneration.
What is the pathophysiology of a prolapsed disc?
· A healthy disc is made up of a distortable, incompressible semi-fluid gel, known as the nucleus pulposus, that is surrounded by a well-organised annulus fibrosus.
· The AF provides resistance to forces and accounts for disc stability.
· The normal human circadian rhythm allows for fluid shifts in and out of the disc.
· Degenerative changes follow a loss of hydration of the nucleus pulposus and lead to a cascade of cellular events.
· This disc degeneration can lead to painful manifestations, include a prolapsed disc.
What is the aetiology of a prolapsed disc?
· Degenerative disc disease.
· Injury to the spine.
What are the potential risk factors?
· Increasing age.
· Occupation - excessive axial loads - e.g. drivers.
· Smoking.
· Obesity.
What are the typical signs and symptoms?
· Pain:
- Exacerbated by activity, relieved by rest.
- Present in certain positions, such as sitting.
· Radicular leg pain - if nerve root compression - sciatica.
· Problems bending/straightening the back.
What investigations would you request if you suspected a patient had a prolapsed disc?
· MRI.
· CT.
Differentials?
· Sprain/strain. · Spinal tumour. · Spinal infection. · Postural back pain. · Intra-abdominal pathology.
What treatment options are available?
· Rest if severe pain, otherwise stay active.
· Analgesia - e.g. paracetamol and NSAIDs.
· Benzodiazepine for muscle pain.
· Persistant sciatica»_space; tricyclic antidepressant
· Gentle exercise.
Complications?
· Surgery-related spinal cord compression.
· Permanent nerve damage.
