A prolapsed (herniated) disc occurs when the outer fibres of the intervertebral disc (its annulus) are injured, and the soft material known as the nucleus pulposus, ruptures out of its enclosed space.

The prolapsed or ruptured disc material can enter the spinal canal, compressing the spinal cord, but more frequently the spinal nerves.

Herniated discs are most common in young and middle-aged adults. A herniation may develop suddenly, or gradually over weeks or months. Disc herniations most commonly occur in the lumbar spine, but also occur in the cervical spine. [2]

Protrusion:

The nucleus pulposus protrudes into the annulus fibrosus.

Prolaps:

The outer fibers of the disc, annulus fibrosus, are injured and the nucleus pulposus enters the spinal cord.

Sequester:

Is the most severe degree of disc  herniation, in which the nuclear material spills out and completely separates with the disc.

The causes of herniations include:

  • Suddenly because of excessive pressure.
  • Bending forwards and attempt to lift an object, which is too heavy.
  • Frequent driving. Staying seated for long periods, plus the vibration from the car engine, can put pressure on your spine and disks.
  • Lesser degree of force – usually due to weakening of annulus fibrosis due to repetitive minor injuries.
  • Men between the ages of 30 and 50 are most likely to have a herniated disk.
  • It is believed that smoking lessens oxygen supply to the disk and causes more rapid degeneration.
  • Being overweight puts added stress on the disks in your lower back.
  • Lift something, twist or bend in a manner, which exerts enough pressure on the disc to cause it to rupture through its weakened outer fibres.
  • No obvious reason. [2]

A herniated disc can cause problems in two ways:

  • Direct pressure:

The disc material that has ruptured into the spinal cord or intervertebral foramen can exert pressure on the nerves.

  • Chemical irritation:

The nucleus material contains a number of substances known as ‘inflammatory mediators’. These cause chemical irritation of the nerve roots and result in inflammation of the nerves. Both the pressure on the nerve root and the chemical irritation can lead to problems with how the nerve root works.

The main symptoms of a prolapsed disc include:

  • Pain along the affected nerves.
  • Paresthesia in form of numbness, pins and needles, or tingling in the area of the sensory innervation of the affected nerve.
  • Weakness involving the innervated muscles.
  • In severe cases, loss of control of bladder and/or bowels, numbness in the genital area, and impotence (in men). (Cauda equina syndrome, affected nerve pudendus S2-S4).
  • The symptoms of a herniated disc may not include back or neck pain in some individuals, although such pain is common. [2]

The examination includes:

  • MRI imaging
  • Reflex testing
  • Paresthesia
  • Test muscle weakness (e.g. walk on heels and toes)
  • Straight leg raise test [1]

 

 

 

 

 

 

 

 

 

 

Disc prolaps L4/5 mediolateral left

Treatment

  • Acupoint-Therapy – Tension-Equalisation-Treatment TET-ventral, Lu7, combined with feet reflexology
  • Massage in the area of the herniation very carefully
  • No heat treatment
  • No weight bearing

Operation techniques

Discectomy:

The most common surgical procedure for a herniated disk in the lower back is a lumbar microdiscectomy. Microdiscetomy involves removing the herniated part of the disk and anyfragments that are putting pressure on the spinal nerve.

Laminectomy:

Laminectomy is the removal of the lamina. A discectomy involves always a laminectomy to get access to the disc. [1]

References:

[1] American Academy of Orthopedic Surgery. (n.d.). Herniated Disc in the Lower Back. Retrieved 04 October 2013 from http://orthoinfo.aaos.org/topic.cfm?topic=a00534

[2] Precision Neurosurgery. (n.d.). Disc Prolapse. Herniation. Retrieved 02 October 2013 from http://www.precisionneurosurgery.com.au/html/conditions_discprolapse.htm