Dr Sachin Tapasvi: Slip Disc – What next?

If I see someone with a very anxious face holding their back with one hand and having extremely stressed out relatives: – the diagnosis is straightforward. Probably the person in question has or is suffering from a ‘Prolapsed Intervertebral Disc’ or “slip disc”. A prolapsed intervertebral disc is a significant issue, both with the patient as well as their family. This is essentially thanks to myths that surround this particular injury. As I did mention in my previous blog, this event is usually a sudden acute event, which usually comes on by lifting or pulling or pushing in a sudden abnormal direction. Most often people are of the opinion that all slip discs “require surgery” and that surgery is usually unsuccessful and is very complicated. But in reality this is far from true..

Most of the prolapsed intervertebral discs will settle and heal with non-surgical treatment. Non-surgical treatment includes taking rest till such time that the pain passes away. This is assisted with the help of medication. Medication essentially is given to decrease the pain, to decrease the inflammation in the muscles as well as the inflamed joint and disc, to decrease the inflammation within the nerve, and to relax the muscle that has gone into spasm. These different factors could cause a substantial amount of pain to the muscle and its surrounding area. In some circumstances, you may find that the medication you have been using hasn’t been as effective as you would have liked, and as a result of this, you may decide to turn your attention toward something similar to CBD oil. This type of oil has been known to help relax muscle tissue, relieve muscle pain, and reduce inflammation, which are the results that you want to see. But, in some severe acute cases, a short course of oral steroids, in a tapering manner is advised. This course of oral steroids help in decreasing the swelling within the nerve very effectively and thereby abolishing the pain. Most often, a five to seven day course of medication and rest is good enough to decrease acute pain and swelling that is associated with the same. In a very select group of patients, when these methods do not ensure alleviation of symptoms, an injection may be suggested. This injection is known as a selective nerve root block. What essentially is done in this is that under x-ray control, the inflamed nerve is injected with a cocktail of a local anesthetic as well as locally acting steroid; which thereby decreases the inflammation. These injections are very effective in taking care of the acute unresponsive pain.

Surgery is usually indicated in very specific situations: – either if the patient has inability to pass urine or motion, there is loss of power or loss of sensation on a area of the lower limb, and or if the pain is so severe that in spite of medicines and the injection it cannot be resolved, then only would surgery be indicated. Surgical treatment usually consists of removal of the protruded part of the disc. This depending upon its location can be done either endoscopically, or by a microscopic surgery with the help of small incisions. These surgeries are very successful and they help in abolishing the symptoms very effectively.

What is more important is the after care following a “slip disc” attack. The reason why the problem recurs and relapses is the absence of a proper post injury rehabilitation program. What is most essential is to correct the abnormal biomechanics and to restore the normal stability in the lower back and pelvis. The muscles that control the lower back also control the pelvic area. The abdominal muscles assist these as well. Hence the balanced strengthening and stretching program that involves the abdominal muscles, the lumber spine muscles and the pelvic muscles is essential. As much as strength is important, flexibility is important too. Yoga, aqua therapy and physical therapy are very useful. The exercise technique of Pilates is extremely useful in bringing back the core stability or the abdomino-lumbo pelvic stability very effectively. Once the strength is restored and the flexibility and endurance established, anyone can lead a normal life. So, as mush as important it is to treat, I feel it is more important to prevent and restore; which will be the key to success.

Dr Sachin Tapasvi

Dr Sachin Tapasvi

Dr Sachin Tapasvi is one of India’s leading joint replacement surgeons. He practises in Pune and has been awarded several fellowships with experience garnered internationally as well as in India. Dr Tapasvi writes every Wednesday on Pune365.
Dr Sachin Tapasvi