Symptoms And Treatment of Herniated Disc:

Acute nerve root compression is usually the result of an acute disk prolapse when the contents of the nucleus pulposus of the intervertebral disk are extruded through a defect in the anulus fibrosus into the spinal canal. There they may irritate the nerve root. The irritation of the nerve root may be due to direct mechanical compression by the nuclear material or as result of the chemical irritation caused by the extrusion. In the older athlete, nerve roots may be compressed by osteophytes formed as part of a degenerative process.

Prolapse usually occurs in disks that have been previously damaged by one of the processes mentioned already. This explains why frequently a minor movement, such as bending over to pick up an object off the floor, may cause such an apparently severe injury. Disk prolapse usually occurs between the ages of 20 and 50 years and is more common in males than females. The L5-S1 disk is the most commonly propalsed disk and L-4-5 the next most common.

Signs and Symptoms

Typically, a patient with a disk prolapse presents with acute low back pain or radicular leg pain (or both) following a relatively trivial movement usually involving flexion.

• On occasions, the presentation may be painless, with weakness or sensory symptoms only.
• The symptoms depend on the direction of the extrusion.
• Posterior protrusions are more likely to cause low back pain with later development of leg pain, whereas posterolateral protrusions may cause radicular symptoms without low back pain.
• Typical symptoms include sharp shooting pain in a narrow band accompanied by pins and needles, numbness and weakness.
• Pain is often aggravated by sitting, bending, lifting, coughing or sneezing.
• Pain is usually eased by lying down, particularly on the asymptomatic and is often less after a night’s rest.
• On examination, the patient often demonstrates a list to one side, usually, although not always, away from the side of pain.
• This is a protective scoliosis. Examination may be difficult if there is severe pain and irritability.
• Straight leg raise is usually limited (less than 30 degree in severe cases) and all active movements, particularly flexion, are usually restricted.
• Palpation usually reveals acute muscle spasm with marked tenderness but occasionally it may be unremarkable.
• A neurological examination should always be performed when pain extends past the buttock fold or there are subjective sensory/motor changes.

Treatment

In the acute phase, the most appropriate treatment is rest in bed in a position of maximum comfort with administration of analgesics and NSAIDs.

• The patient should lie as much as possible and avoid sitting.
• Extension exercises should be commenced as soon as possible. However, if exercises cause an increase in peripheral symptoms, they should be ceased.
• Mobilization techniques should be performed with great care.
• Rotations may be effective but should be performed gently as patients with disk prolapse may be made considerably worse with aggressive mobilization.
• Manipulation is contraindicated in conditions with acute neurological signs and symptoms.
• Traction is often helpful in the treatment of acute disk prolapsed with distal symptoms.
• However, it is not uncommon for the patient to experience considerable pain relief while undergoing traction, only to have increased symptoms after treatment.
• A transforaminal epidural injection of corticosteroid may help if there is no significant improvement in symptoms and signs with rest.
• Surgery may be required if neurological signs persist or worsen. If bowel or bladder symptoms are present, emergency surgery may be necessary.
• An open Laminectomy or percutaneous diskectomy using a needle aspiration technique may be performed.
• Chymopa pain injection may be helpful when a unilateral disk bulge is present.
• As the acute episode settles, it is important to restore normal pain-free movement to the area with localized mobilization and stretching.

 Following restoration of range of movement, active stabilization exercises should be performed. Postural advice, including correction of poor lifting techniques and adjustment of sporting technique, where necessary, is most important.