By Dr Mahesha K

Mangaluru, Sep 29: Back pain is a very common illness next only to common cold and toothache. It can affect any person at any age and time. Back pain can be due to various causes starting from a simple strain, postural problems, disc prolapse, osteoporosis, spondylosis, infections, tumors, inflammatory disorders, extraspinal causes and sometimes psychological reasons. Disc herniation is a common cause for back pain. 

Disc Prolapse

What is disc?

In the human body, the spaces between the backbones are filled with a soft gelatinous material called disc.

What is disc prolapse?

Disc prolapse is a disease in which the Intervertebral disc slips from its normal position. This slip can occur when the patient tries to lift a heavyweight and experiences a catch in the back. This slip can also occur after a heavy exertion, prolonged travel or unaccustomed activity or fall. Sometimes, disc prolapse can occur without any reason.

Symptoms of disc prolapse

1. Back pain: Back pain may start on its own or after lifting heavy weights. Pain increases on coughing or straining. Sometimes, pain may be severe and there may be difficulty in sitting, standing and walking.
2. Leg pain or sciatica: If the disc prolapse is pressing on the nerves, the patient will get shooting pain in one or both the legs called sciatica.
3. The patient may experience numbness or weakness of one or both the legs.
4. Rarely, there may be difficulty in passing urine or motion. If this happens, it is an emergency because if surgery is not done within 48 hours, the patient will not recover for the rest of the life.

Diagnosis of disc prolapse

Disc prolapse can be diagnosed by clinical examination. When the leg is lifted straight up, if there is a pain in the leg, it is suggestive of disc prolapse. By examining the muscle power, sensations and reflexes, the doctor is able to diagnose the level of disc prolapse. The diagnosis is confirmed with X-ray and MRI scan.

Treatment of disc prolapse

90 percent of disc prolapse can be cured without any surgery. Non-surgical treatment includes rest, painkillers, belt, traction, exercises and physiotherapy. However, in 10 percent of the cases, surgery is required.

Types of surgery for disc prolapse

Previously, open surgery (Laminectomy and discectomy) was performed for disc prolapse. However, laminectomy is a destabilizing surgery. The patient needs to stay in the hospital for two weeks and needs to take rest at home for three months. The back and its supporting structures are permanently scarred. The patients continue to have back pain and are disabled for the rest of the life. There are long-term complications such as spinal instability, epidural fibrosis, and recurrent disc prolapse. If there is any complication, it may require spinal fusion. With the advent of microdiscectomy, these complications are less but still persist. The latest surgery for disc prolapse is called transforaminal endoscopic disc surgery which is a keyhole surgery. It is completely different from traditional surgery because it is done through the natural opening in the spine called intervertebral foramen.

Endoscopic disc surgery

Now it is possible to remove a herniated disc with an incision of 7 mm under local anaesthesia. It is a day care procedure with no hospital stay. The advantages of percutaneous endoscopic discectomy are:
1. Minimally invasive
2. Least morbidity
3. Done under local anaesthesia
4. No need for blood transfusion
5. No IV fluids
6. No stitch
7. No catheterization
8. Daycare procedure. The patient can get discharged in a few hours after surgery.
9. Reduced rate of complications
10. Cost-effective
11. Rapid recovery
12. Even with previous open surgery, it is possible to operate
13. It can be done in patients who are not fit for general anaesthesia.
14. Surgery does not damage the muscles, bone and ligaments of the spine.
15. No scar in the back.
16. No implants or screws.

How surgery is done?

Generally, surgery is done under local anaesthesia. If the patient wants, it can be done under epidural anaesthesia. Surgery involves two parts. The first part is done under image control to enter the disc using needle, guidewire, dilator and cannula in sequential manner to enter the disc.

Insertion of needle
(from left to right)

The second part is the removal of the disc under vision using the endoscope and various instruments. Once the disc herniation is removed, the patient will experience relief from pain. At the end of surgery, nerve roots and spinal cord are fully relieved of compression.

Insertion of endoscope

Disc fragment removed

Disc

Scar

MRI scan before surgery

MRI scan after surgery

Scarless back

Other indications for keyhole spine surgery

1. Recurrent disc prolapse
2. Infections of spine- discitis, epidural abscess
3. Spinal canal stenosis
4. Spinal biopsy
5. Cauda equina syndrome.

For more information, contact:

Dr Mahesha K
M.S.(Ortho)., D.N.B.(Ortho)
Maithri Speciality Clinics, near Hotel Maya International
Bendoorwell, Mangaluru - 575002
Telephone: Landline: 0824 - 2446068 Mobile: 9449116068
E-mail: maheshakb@yahoo.com