The term Slipped Disc refers to a disc bulge (protrusion) or a ruptured disc (disc extrusion or sequestrum) Slipped discs may arise in the neck (cervical spine), back of chest (thoracic spine) or lower back (lumbar spine).
This image demonstrates 2 slipped discs or protrusions oushing backwards from the disc on to the nerves in the spinal canal.
Symptoms
In the lower back, they cause various combinations of back pain, buttock, groin or leg pain by irritating the adjacent nerves and from irritation within the disc itself. This pain is loosely termed Sciatica. When the slipped disc presses on the nerve, it may cause numbness or pins and needles in the leg. This may be associated with weakness such as “foot drop” (difficulty lifting the toes and foot up) or weakness when pushing off with the foot.
In the neck, they may produce neck pain, headaches and pain in the face, shoulders arms and hands. When the slipped disc presses on the nerves in the neck, it may cause numbness or pins and needles in the face, shoulder, arm or hand. This may be associated with weakness of shoulder, elbow, wrist or hand movements.
Treatment
The symptoms arising from the first attack of a slipped disc settle down over the first 6 weeks and half of the remainder will settle over the next 6 weeks. Treatment during this period is focused upon reducing the irritation with anti-inflammatory drugs (Steroids or Non-Steroidal Anti-Inflammatory Therapy such as Ibuprofen, Diclofenac, Acemethacin) and correcting posture and maintaining mobility by using Muscle Balance Physiotherapy.
Repeated attacks or enduring symptoms need more radical treatment and these may be grouped in to 3 treatment pathways: Conservative Therapy, Conventional Open Surgery and Endoscopic Minimally Invasive Spine Surgery.
Conservative therapy consists of Muscle Balance Physiotherapy, injection, Cognitive Behavioural Therapy and coping courses and a restricted lifestyle and the hope that the symptoms will abate over time. Whilst not without risk altogether surgical options carry greater risk and can not guarantee success. The surgical options are tabulated below and details of these treatments may be explored through the list on the right
| Procedure | Complications | Success @ Year 2 |
| Microdiscectomy | 6% (Recurrent Protrusion 3 – 17%) | Leg pain but not back pain 90% |
| Open Decompression | 8% (Instability and scarring) | Poor data @ 75% |
| Instrumented Fusion | 11 – 18% (International Controlled Trials) | 60% |
| Total Disc Replacement | 16 – 45% | 50% |
| Interspinous Spacers | Spinous process fractures, settlement, infection | Insufficient data |
| Endoscopic Minimally Invasive Spine Surgery (Transforaminal) | 2.4% | 80% |
Our experience of 3.800 Endoscopic Lumbar Decompression and Foraminoplasty procedures has shown encouraging results in over 80% of patients treated for Slipped discs, Failed Back Surgery, Failed Fusion Surgery, Spine Instability. Chronic Lumbar Spondylosis and Back pain, Lateral Recess Stenosis and Axial Stenosis, Spondylolytic Spondylolisthesis, Disc infections. Our current and yet incomplete survey of patients operated upon 10 years ago is proving surprisingly encouraging.
