Understanding Your Treatment Options for a Slipped Disc

What is a herniated disc?

A herniated disc is commonly known as a slipped disc. It occurs when one of the "rubbery cushions" or discs that sit between the bones along our spine, known as vertebrae, gets compressed. It can affect any disc in the entire spine and, depending where it occurs, can cause pain in your neck or back that may extend to your limbs, as well as cause numbness or weakness there.

What causes a herniated disc?

Herniated discs can happen around the ages of 20 – 50 years old. In the younger age group, this is usually due to some form of trauma or excessive force experienced during a movement. As we age, the discs start to experience wear and tear, and become desiccated (dried up), resulting in them being more prone to rupturing, which may occur as you twist your back, lift heavy objects, or as a result of a fall.

Am I at risk of disc herniation?

In addition to the age factor, you are more prone to disc herniation if:

• You are overweight – This puts extra stress on the discs in your lower back
• There is a family history – This is a genetic factor so you may inherit a disposition towards herniating a disc
• You smoke – Smoking reduces the oxygen supply to the discs, allowing them to wear down more quickly
• You have a physically demanding job – Repeated lifting, bending, twisting and pulling can put added pressure on your spine and increase your risk of a herniated disc

What are the symptoms of a herniated disc?

Symptoms usually affect just one side of the body and affect the part of the body served by the affected nerve. If you experience any of the following symptoms, consult an orthopaedic specialist for diagnosis and treatment.

• Pain – If you have herniated a disc in your lower back, you may feel a sharp or burning pain in your buttocks, thigh or calf. If the affected disc is in your neck, the pain is felt in your shoulder or arm. Sudden involuntary actions, such as coughing or sneezing, may result in a shooting pain.

• Numbness/Tingling – You may feel a radiating numbness or tingling in the area served by the affected nerve.

• Weakness – Muscles served by the affected nerve may weaken.

Seek medical treatment immediately if the symptoms worsen. In serious cases, you may experience difficulty urinating, lose control of your bladder or bowel, or even experience a loss of sensation in the inner thighs, back of the legs, or around the rectum.

How can I avoid a herniated disc?

Besides following safe practices when lifting heavy loads, practise maintaining good posture. You can also do exercises to strengthen your core, which will better support your back. Aim to maintain a healthy weight and avoid smoking.

What non-surgical treatments can I try to treat a herniated disc?

Most people with a herniated disc don't require surgery. Some physical therapy and daily gradual exercise coupled with pain relief in the short term should have you back to your normal self within 6 – 8 weeks.

Moderated activity

By modifying your activities for a few days or weeks, you may be able to relieve your symptoms and get back to your daily activities. However, don't fall into the trap of resting too much. You want to keep active to stop your joints and muscles from stiffening. Perform activities that don't put a strain on your back and avoid lifting anything heavy. You may need over-the-counter pain killers to relieve the pain. Your doctor may also prescribe muscle relaxants if you have muscle spasms. Listen to your body and adjust your level of activity based on the level of pain that you experience. You can also ask to be referred to a physical therapist to learn some exercises to minimise the pain from a herniated disc.

Pain relief

If you are not able to tolerate the pain with exercises, and over-the-counter medication doesn't help, your doctor may step up pain blocking with a corticosteroid that can be injected into the area around the spinal nerves. This may involve your surgeon using spinal imaging to help guide the needle to the right place. If these steroid injections can't relieve the pain, over the short-term, your doctor may, as a last resort, prescribe an opioid such as Codeine or an oxycodone-acetaminophen combination such as Percocet.

You can also try some home remedies such as applying cold packs on the area to reduce inflammation in the first few days, followed by hot packs thereafter to provide relief and comfort.

Surgical options

Surgery isn't required for 9 out of 10 people who suffer from a herniated disc. However, if non-surgical treatment options do not work, or if the condition is left untreated, it may lead to permanent nerve damage. In rare cases, it can cut off nerve impulses to your lower back and legs, which can cause loss of bowel and bladder control. You can also lose sensation to your inner thighs, the back of your legs and around your rectum/anus.

Before you experience any of these symptoms or if your condition worsens in any way, you should discuss the need for surgical intervention with your doctor.

You are likely a candidate for surgery if:

• the herniated disc presses against a nerve in the spinal column causing pain numbness, or weakness in the part of the body where the nerve travels
• the pain does not respond to pain relief, anti-inflammatory drugs or physiotherapy
• the herniated disc affects the nerves that control the bladder and bowel

What surgical options are there?

You will undergo lumbar spine surgery for herniated discs in the lower back, and cervical spine surgery for herniated discs in the neck region. Depending on the type of hernia, your surgeon will consider one or a combination of the following procedures:

Discectomy/microdiscectomy

This is the most common surgery used for herniated disc in the lumbar spine or lower back region. Your surgeon will remove the portion of the disc that is causing the pressure on your nerve root and may remove more disc as necessary. The procedure is performed through an incision in your back. In a microdiscectomy, special instruments may allow your surgeon to perform the surgery through a smaller incision, with the use of a microscope, depending on suitability.

Laminotomy/laminectomy

In a laminotomy, your surgeon aims to relieve pressure on your nerve roots by making a small opening to create a window in the vertebral arch (lamina). When your surgeon needs to remove the entire lamina to achieve this, the surgery is known as a laminectomy.

Artificial disc surgery

As the name suggests, this surgery involves replacing a single damaged disc with an artificial one. Your surgeon will perform this surgery under general anaesthesia through an incision in your abdomen or neck and you may need to stay in hospital for a few days following surgery. Suitability for this procedure needs to be discussed with your surgeon carefully as it is not suitable for patients with herniation of multiple discs or if they suffer from arthritis or osteoporosis.

Spinal fusion

If you require spinal fusion, your surgeon will permanently fuse two or more vertebrae together using bone graft from another part of your body, from a donor, or from an artificial source.  The graft may be applied together with metallic screws/rods/plates or plastic cages for additional support. The operation is performed under general anaesthesia and you may be expected to remain in hospital for several days.

Managing risks and expectations

As with any surgery, spinal surgery comes with some risks. General surgical risks include infection and bleeding. Specific risks for disc surgery include disc recurrence, re-rupturing, implant failure, fusion failure, and neural damage, although due to technological advancement, these issues are rare.  If you suffer from degenerative disc disease, there is the added possibility of developing problems later on with other discs that are not addressed during the surgery.

Most people recover well after disc surgery. The extent and speed of your recovery will depend on the type of surgery you have, any complications encountered and how closely you follow your surgeon's instructions. Your surgeon will instruct you on when to resume normal activity, when you may begin exercising and whether you will need to undergo physical therapy.

If you suspect you have a herniated disc, consult an orthopaedic surgeon to evaluate your condition and find out what treatment is suitable for you.