What Is A Prolapsed Intervertebral Disc?

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Prolapsed Intervertebral Disc is a common term in the orthopedic world. It refers to a condition in which an intervertebral disc expands under specific circumstances and eventually exerts pressures on the related nerve root causing sharp pain. This phenomenon of the disc losing its original form and expanding is called intervertebral disc bulging.

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The herniation of a spinal disc is a subsequent result of a prolapsed intervertebral disc. In this form of herniation, the annulus fibrosus ring also called the outer fibrous ring gets torn and makes way for the nucleus pulposus (soft central part) to bulge out.

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What Puts You In The Danger Of A Prolapsed Intervertebral Disc?

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According to the best Orthopedic surgeon in Delhi NCR, Dr. Deepak Chahar, the following are the top activities that put people in danger of developing a PIVD-

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1. Chronic obesity- Being overweight is by far the leading cause of PIVD in people. In people with excess body fat, spinal degeneration occurs at a much faster pace. Spinal degeneration and excess load can lead you to a prolapsed disc.

2. Inactive Lifestyle- People who do not frequently engage in physical activities tend to have weaker neck and back muscles. These people are more prone to a prolapsed disc due to increased strain on the back muscles and spine.

3. Repetitive and continuous mechanical exertion- Individuals who frequently engage in heavy load lifting and do so without proper support and break are also at risk of a herniated disc.

4. Bad posture for a long time- Sitting for a long time while slouching is bad for your spine and increases the load on the discs.

5. Traumatic injury to lumbar discs- Common occurrence when lifting while bent at the waist rather than lifting with the legs while the back is straight.

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Typical Symptoms Of A Herniated Disc

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The signs and symptoms seen in prolapsed intervertebral disc greatly vary according to the location of the disc involved and also the affected soft tissue type. Some of the classic symptoms a patient with herniated disc exhibits are as follows-

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1. ‘Pins and needles’ or ‘electric’ sensation in legs. Leg pain is also a common complaint.

2. Weak upper limbs but are not necessarily numb or tingly.

3. Shoulder pain can be a complaint depending on the location of the disc involved.

4. The nature of pain can also greatly vary from mild, moderate to severe, and sharp.

5. In extremely rare cases control of bladder and bowel is lost.

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How Do Targeted Injections Help In Alleviating Pain?

 

There are various types of orthopedic issues and there are also all sorts of treatment modalities. But the one most preferred by any patient would be something that saves them from being cut open. The targeted injection technique offers relief to patients as it is a conservative approach towards pain relief. These techniques help a doctor in not only locating the site of pain but also deliver pain relief medication directly into the anatomic location of interest. The medicinal relief achieved by injections is not only faster but lasts longer than oral medication.

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These medicinal Injections alleviate orthopedic pain in patients in the following ways:

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1. Directly supply the anatomical area of interest with steroid and/or other pain-relieving medication for quick relief from pain and inflammation.

2. Create a heat lesion (radiofrequency ablation) on a pain-transmitting nerve to prevent it from sending pain signals to the brain.

3. Injections can also play a diagnostic role and point out the anatomic site of pain, such as a herniated disc or a compressed nerve. Diagnosis And Treatment Modalities For PIVD

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Dr. Deepak reaches a diagnosis on the basis of the case history given by the patient, symptoms as described by the patient, and physical examination. Following primary diagnosis, the following test imaging is done to further get clarity about the condition:

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1. X-rays- It shows unnaturally narrow disc spaces and loss of lumbar lordosis.

2. CT Scan lumbar spine- It focuses on the shape and size of the spinal canal, its contents, and the structure around it including soft tissues. It is done to assess the herniation.

3. MRI lumbar spine- Intervertebral disc protrusion and compression of the nerve root are apparent in MRI.

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Following primary diagnosis and diagnostic imaging, Dr. Deepak makes a treatment course for the patient depending on the severity of their condition. Dr. Chahar has a clear inclination towards managing the patient non-surgically but it is to notice that a non-surgical approach may work on one patient better than the other.

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Some of the common non-surgical treatment approaches involve

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1. Pain medications

2. Appropriate bed rest

3. Oral steroids

4. Nerve root block with the targetted injection technique

Advised Treatment Approach By Dr. Deepak

1. Nonsteroidal anti-inflammatory drugs or NSAIDs for example- aspirin, and Ibuprofen.

2. Oral steroids like prednisolone or methylprednisolone.

3. Epidural cortisone injection.

4. Physical therapy includes modalities to temporarily relieve pain(i.e. traction, electrical stimulation massage)

5. Patient education about right and wrong body posture.

6. Weight control

7. Tobacco cessation

8. Lumbosacral back support.

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Dr Deepak Chahar observed that most PIVD cases can be managed without surgery ,unless showing warning signs which constitute less than 10 percent of the cases.

But in most cases this conservative management takes weeks or months. Few patients lose patience and end up with unwarranted surgeries.

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To promote non surgical management of PIVD(Disc) Dr Deepak follows accelerated conservative management protocol involving Medicines, Physiotherapy and targeted injections.

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Dr Deepak Chahar underwent certificate course in pain management from Gangaram Hospital, Delhi where he explored the various targeted injections for PIVD and other musculoskeletal problems.

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Transforminal Epidural Steroid Injections, Facetal blocks and caudal epidural blocks have shown faster recovery in patients when used in conjunction with conservative management.

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This protocol avoids the need for surgery in most of the cases and also spares the patient from slow and troublesome medical management. In today’s time when daily man hours are important and time is precious, Accelerated recovery boosts patient confidence and helps patient return to normal lifestyle as early as possible.