Back pain related to a Disc wall bulge / Slipped disc

 
  • Low Back pain ± buttock pain
  • Aggravated by flexion / extension of the back ± coughing / lifting eased by lying down
  • No associated systemic disease such as cancer
  • No or limited slippage of one vertebra upon the next
  • No disturbance of sphincter function or loss of sensation in the perineum
Presentation Diagnosis  Options 
 First episode <6 weeks duration  Muscle strain or facet joint strain  Muscle Balance Physiotherapy
Prolapsed disc irritating the local nerve Muscle Balance Physiotherapy, anti-inflammatory medicines, pain controlling medicines (Conservative Care)
First Episode >6 weeks duration
NOT responding to Muscle Balance Physiotherapy
 
Prolapsed Disc irritating the local Nerve
± High Intensity Zone or disc leaking pain producing products
 
MRI Scan advised
Further Conservative care + increased analgesia,
Nerve root blocks, Caudal epidural injections, Facet Joint Injections. (Chronic Pain Management)
Recurrent repeated episodes
Failed Chronic Pain Management
Prolapsed Disc irritating the local Nerve
± High Intensity Zone or disc leaking pain producing products
 
Endoscopic Lumbar Decompression & Foraminoplasty / Microdiscectomy.
Worsening signs of weakness or numbness ± lessening back pain Increasing size of prolapse and nerve root compression ± disc wall disruption & extrusion. Endoscopic Lumbar Decompression & Foraminoplasty / Microdiscectomy.