Questions and Answers about Spine Problems
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Please go through these questions in order to assess your problem
Q n A
Q.WHAT IS A SLIPPED DISC?
It is also called as Herniated Disc .Our Spine is made up of a number of small bone blocks called VERTEBRAE stacked one on top of another. A disc is a soft, gel-like structure present between two adjacent vertebrae. Normally, these discs act like SHOCK-ABSORBERS and also allow some movement between the two adjacent vertebrae, giving the spine its flexibility. When this disc slips beyond its normal confines, it can compress the spinal cord or its nerve roots leading to problems.
Q.WHY DOES THE DISC SLIP OUT?
Over the years, the disc develops small tears, which may unite together over a period of time and with some small injury (Lifting a heavy weight / bucket, Long travel on a bad road, bending forwards, jerk) the disc may slip out of its normal place and press the nerve. Sometimes as a part of the normal aging process, the spine may develop some extra bone growth, leading to pressure on the adjacent spinal cord or its nerve roots leading to pain.
Q.WHAT ARE THE GRADES/STAGES OF SLIPPED DISC?
STAGE 1 Disc: Degeneration –Disc stops
Working – becomes Non functional – pt feels
Difficulty in bending forwards and long sitting. Small jerk lead to severe pain
STAGE 2 Disc: Protrusion Nucleus comes out of disc but still attached to it.
STAGE 3 Disc: Extrusion Nucleus Comes out but attached by a thin base to the main disc
STAGE 4 Disc: Sequestration – Disc bursts and its small fragments start pressing the nerves Lead to severe pain. Requires Surgery
Q.WHY IS THE PAIN NOTICED IN THE LEG, WHEN THE DISC HAS ACTUALLY SLIPPED OUT IN THE SPINE?
The nerve which supplies the buttock, thighs, leg, calf and foot starts from the spine. So, if there is some pressure at the starting point, there will be pain in the region where the nerve travels and supplies.
Q.IS THERE ANY NONSURGICAL TREATMENT FOR SCIATICA?90 % of such cases get better by bed rest and medicines.
Q.HOW SHOULD YOU SLEEP?
You should sleep on your side, either right or left, whichever is comfortable, with a pillow in between your legs.
Q.WHAT KIND OF BED SHOULD YOU SLEEP ON?
A FIRM mattress is ideal!!! No need to sleep on hard beds, nor you need “spine-friendly” expensive mattresses sold out in the market.
Painkillers will be prescribed to allow a smoother and easier return to normal function. In addition,, you may also be prescribed muscle relaxants so as to relax and soothe your back muscles. This is so because whenever you have neck or back pain, your muscles tend to go into spasm (contraction) and hence, lead to pain. It is essential to break this spasm with a muscle relaxant so as to give effective pain relief.
After pain relief, you will have to do physiotherapy as spinal exercises.
You would need to have some activity restrictions to help your spine get back into shape and stay that way!! You would not be allowed to bend forwards; sit on the floor; lift weights; travel (particularly not on 2 and 3 wheelers). These restrictions would be generally enforced for a minimum period of about one month.
Q.WHEN IS SURGERY ESSENTIAL?
Surgery would be indicated when
> There is no pain relief despite symptomatic treatment as mentioned above
> when there is significant leg weakness
> repeated attacks of sciatica so as to get a permanent solution to the problem
> there is difficulty in passing urine or stools/motions.
Q.WHAT IS THE NATURE OF SURGERY?
Minimally Invasive Discectomy is the usual surgery for sciatica. This is a surgery performed through a very small incision (2 cm).
IS IT A MAJOR SURGERY? WHAT ARE THE RISKS INVOLVED?
Everything in life carries some small risk associated with it. The option for surgery would be offered only if the benefits of surgery are more than the risks. Rather than asking as to what are the risks of going in for surgery, it would be more logical to ask as to what are the risks and benefits of getting the surgery done as compared to not getting the surgery done?
Spine surgery has had a lot of advances in the past decade or two; there are better imaging facilities like MRI, better surgical instruments to further increase the safety level of surgery, better training and information in an overall sense making spine surgery no longer the taboo that it once was! So, if you have a problem that genuinely requires surgery, there is no point in tying yourself down to the bed for days or months on end.
Q.CAN WE NOT REPLACE THE DISC BACK INTO ITS PLACE; IN OTHER WORDS, WON'T IT BE HARMFUL TO REMOVE THE DISC?
The disc that has slipped out can no longer carry out its normal function; rather, it is causing harm to the body rather than doing anything good! So, trying to replace the disc back into its position is not a viable option.
Q.WILL I BE ABLE TO RETURN BACK TO WORK AFTER THE SURGERY?
Though you would be up and about, walking about within the first 2 days following the surgery, you would be allowed only limited mobilization within the house in the first one month following surgery. Thereafter, if you are having a sedentary light job, then you may be allowed to resume work, provided you do not have to travel for a prolonged time on some bumpy road(s).
If you were having some job that required some moderate labor, you would be allowed to resume work about 3 months after surgery.
When to show to spine specialist?
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