The discs lie between the end surfaces of the bony blocks (vertebrae) that make up the spine. They have a soft jelly like centre which is surrounded by a tough outer ring. The intervertebral discs act as shock absorbers and also permit movement of the spine. The nerves which run from the brain to the arms and the legs lie within the spinal canal and pass very close to the back of the discs.
Sometimes due to an increase in pressure on the disc, a tear in the tough outer ring can result and the soft centre may slip out (prolapse) pressing on a nerve. This commonly occurs in the lower back (lumbar) but may also occur in the neck (cervical).
Once a prolapse occurs resulting in pressure on a nerve, pain is felt shooting down the arm or the leg (sciatica). Pins and needles are often felt in the foot, toes or in the hands and weakness of the muscles served by the nerve may also occur. Rarely, a large prolapse will press on nerves to the bladder leading to loss of control over the bladder.
Although a diagnosis is often made by sound clinical judgment, a MRI may be necessary to confirm the diagnosis.
In the majority of cases, surgery is not required as often the pain subsides with rest at home and analgesics. If there is no alleviation of the pain, then strict rest in hospital may be needed for an additional period of time.
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C6-7 disc prolapse causing left C7 root compression |
Surgery is carried out to relieve persisting pain in the arms or legs. It is not generally used for back or buttock pain, or local discomfort in the neck. When the patient is unable to pass urine, or if muscle weakness is increasing rapidly, then immediate surgery is necessary.
Nowadays, a minimally invasive technique of disc surgery (microdiscectomy) is performed to relieve the symptoms. In a microdiscectomy or a microdecompression spine surgery, a small portion of the tissue over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal.
Micordiscectomy in progress
Cervical and lumbar microdiscectomies are regularly done in our hospital and 194 microdiscectomies were performed in the year 2007.
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