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what is the lumbar disc prolapse?

the intervertebral disc formed of outer fibrous layer (annulus fibrosus) and inner soft layer (nucleus pulposus) so lumbar disc prolapse occured when the nucleus bulges out (herniated) through a weakness in the outer layer which will compress on nearby structures such as spinal nerve roots or spinal cord itself.

Risk factors:

  • A job involving lots of lifting.
  • A job involving lots of sitting.
  • Weight-bearing sports.
  • Overweight.
  • Smoking.
  • Increasing age.

Symptoms

although many cases of disc prolapse may be asymptomatic. symptoms can be divided into back pain and leg pain. Back pain is derived from the interruption of the outer fibrous layer which called discogenic pain and usually it’s a sharp pain radiating to the back of the thigh and increased by straining or sudden movement.

leg pain is derived from nerve root or cord compression involving the whole distribution of the affected nerve root and the sciatic nerve is the most common nerve affected with lumbar disc prolapse and this pain represented as burning, electric shooting or wipe like lancenating pain associated with tingling, numbness and thermal changes increased by walking and lifting heavy objects.

The most dangerous symtoms of the herniated disc is the cauda equina syndrome which characterized by problems with bowel and bladder function or numbness around saddle area and weakness on both or one of lower limbs

Diagnosis

Correlation between clinical examention with MRI findings and other special tests such as EMG or plain x-ray.

Management

There are three lines of treatmaen: conservative, mininmally invasive disc decompression and surgery.

  1. Conservative: medical treatment, physical exercise and physiotherapy.
  2. Minimally invasive disc decompression: percutaneous aspiration of the disc nucleus under local anesthesia guided by x-ray flouroscopy which typically done on outpatient basis alleviating the possible complication of open surgery and general anesthesia and preserving the disc strength and future treatment options including surgery.Advantages:
    • Significant pain relief
    • Local anesthesia
    • Rapid recovery
    • Minimal tissue damage and blood loss
    • No scarring
    • Minimal risk of infection
  3. Surgery: it’s the most aggresive treatment option and nowadays it has a limited indications such as foot drop or cauda equina symptoms.

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