Prolapsed Disc (Slipped Disc)
Understanding the back
The spinal cord, which contains the nerves that come from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to relay messages to and from various parts of the body.
Strong ligaments attach to the vertebrae. These give extra support and strength to the spine. Various muscles also surround, and are attached to, various parts of the spine. (The muscles and ligaments are not shown in the diagram below, for clarity.)
What is a prolapsed disc?
Any disc in the spine can prolapse. However, most prolapsed discs occur in the lumbar part of the spine (lower back). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.
Who gets a prolapsed disc?
The most common age to develop a prolapsed disc is between 30 and 50 years. Twice as many men as women are affected.
What causes a prolapsed disc?
What are the symptoms of a prolapsed disc?
Nerve root pain (usually sciatica)
Other nerve root symptoms
Cauda equina syndrome - rare, but an emergency
Some people do not have symptoms
How does a prolapsed disc progress?
Do I need any tests?
Tests such as X-rays or scans may be advised if symptoms persist. In particular, an MRI scan can show the site and size of a prolapsed disc. This information is needed if treatment with surgery is being considered.
What are the treatments for a prolapsed disc?
Exercise and keep going
In the past, advice had been to rest until the pain eases. It is now known that this was wrong. You are likely to recover more quickly and are less likely to develop chronic (persistent) back pain if you keep active when you have back pain rather than rest a lot. Also, sleep in the most naturally comfortable position on whatever is the most comfortable surface. (Advice given in the past used to be to sleep on a firm mattress. However, there is no evidence to say that a firm mattress is better than any other type of mattress for people with back pain.)
- Paracetamol is often sufficient if you take it regularly at full strength. For an adult, this is 1000 mg (usually two 500 mg tablets), four times a day.
- Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatories.
- A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. This may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
- A muscle relaxant such as diazepam is sometimes prescribed for a few days if the back muscles become very tense and make the pain worse.
The aim of surgery is to cut out the prolapsed part of the disc. This often eases symptoms. However, it does not work in every case. Also, as with all operations, there is a risk from surgery. A specialist will advise on the pros and cons of surgery, and the different techniques that are available.
Can further bouts of back pain and/or prolapsed disc be prevented?
Further information and advice
Backcare (The National Back Pain Association)16 Elmtree Road, Teddington, Middlesex, TW11 8ST
Telephone Helpline 0845 130 2704; Web: www.backcare.org.uk
The Back BookA reliable source of information. It is written by a team consisting of a GP, orthopaedic surgeon, physiotherapist, osteopath, and psychologist and provides comprehensive advice. Roland, M.O et al. (2002) The Back Book. London: The Stationery Office.