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Praxis für Neurochirurgie
Dr. Elmar Patz
Dr. Patz with CT scan

Slipped disc in cervical
or lumbar spine:

In Germany backache is the second most common reason for medical treatment. In the vast majority of cases symptoms improve within 6 to 8 weeks under conservative therapy, i.e. without surgery. The intervertebral (spinal) disc consists of a soft gel-like core (nucleus pulposus) and a tough outer ring of fibre (anulus fibrosus). The ageing process and heavy physical effort can bring about degenerative changes throughout the disc including a reduction in the water content of the gelatinous core and little tears in the outer ring of fibre. This may cause the soft material of the nucleus to bulge out – resulting in a so-called herniated intervertebral disc - what is commonly known as a slipped disc. The rear of the disc at the side is subject to the heaviest load, and it is at this very point that the stabilising posterior longitudinal ligament is particularly weak. This is why most slipped discs occur at this weak spot – at the back and side – often compressing a nerve root and resulting in the neurological symptoms and pain typical of this condition.

Clip Anatomy of slipped disc
Clip of anatomy
Slipped disc

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Symptoms:

The principal symptom is pain radiating out in one extremity of the body (radicular pain), with a pattern that is typical of each nerve root. Progressive damage to the nerve root will cause specific neurological symptoms, e.g. feeling of numbness or tingling as well as palsy affecting certain muscles. This may additionally result in the failure or impairment of bodily reflexes. Large disc herniation in the lower lumbar region may impair bladder and bowel function as well as causing problems with potency. The radiating pain involved here typically increases with coughing, sneezing and straining. Relief can be obtained by raising the legs and bending them at an angle of 90° ("step-bed").

Illustration of slipped disc
Illustration of slipped disc

 

Diagnosis:

A computer tomography (CT) scan is generally sufficient for diagnosis in the case of the lumbar spine. As this examination however exposes the patient to a dose of radiation, magnetic resonance imaging may also be used in certain cases. With the cervical spine the first step should always be magnetic resonance imaging, which shows the intervertebral discs more clearly, and if this is insufficient (assessment of bony structures), a CT scan can be arranged if required.

Surgery:

The diagnosis of "root compression syndrome with a herniated disc" is always reached after carefully considering the patient's clinical symptoms and X-ray findings. Only then can a strategy for further treatment be devised in discussion with the patient.
Should symptoms fail to show sufficient improvement under conservative therapy after 6-8 weeks or if neurological problems occur, patients can be offered surgical removal involving the slipped disc. It is only the herniation itself that is cut away here: the disc itself is only partly removed.

A range of different surgical techniques are now available. At our practice all operations are performed using microsurgery, involving an operating microscope and a small, minimally invasive incision. With surgery on the lumbar spine, sometimes an endoscope is all that is required. In the case of the cervical spine discs are mostly cut away dorsally (from the back). With large central disc herniation surgical access is from the front (ventrally), involving removal of the entire disc, followed by the insertion of a prosthetic (artificial) disc. In the case of the lumbar spine discs are removed dorsally (from the back). Besides open microsurgery, we also offer very minimally invasive endoscopic removal
(keyhole surgery) under local anaesthetic using the Thessys™ technique..

Also see:

» Bony narrowing of the spinal canal
» Nerve compression syndrome of the hand
» Nerve compression syndrome of the elbow
» Chronic backache

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Praxis für Neurochirurgie · Dr. Elmar Patz · Boxgraben 95 · 52064 Aachen