Slip Disc Treatment in Pune
Disc herniation means the cushion that sits between the spinal bones (vertebra) is pushed outside its normal position. Since the spinal nerves are in close proximity to these discs, thus the herniation of disc produces problems along with the nerve distribution i.e; electric-like shock or pain goes down along the leg (in lumbar slip disc patients) or arm (in cervical slip disc patients).
When the spinal cord or spinal nerves become compressed due to slip disc, they don’t work properly. This means that abnormal signals may get passed from the compressed nerves (eg: pain, tingling), or signals may not get passed at all (eg: numbness/weakness/paralysis). Common symptoms of a herniated disc include:
Electric shock pain
Pressure on the nerves can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shock goes to your arms. But when compression occurs in the lumbar (low back) region, the shock goes to your legs (also known as sciatica).
Tingling & Numbness
This type of abnormal sensations is commonly experienced with a slip disc. These pins and needles sensations occur in the arms (in cervical slip disc patients) and legs (in lumbar slip disc patients). Similarly, some patients complain of numbness in the same area.
We already know – our brain orders commands and body follow those orders. Signal for anybody action (eg: foot movement or hand movements) starts in the brain goes down to the spinal cord then goes to the spinal nerves and then to arms or legs. In severe form of slip disc, nerve pinch is also significantly more and thus brain signals are interrupted much more leading to muscles weakness. In other words, the brain wants to move the foot (or the hand) but is unable to do so. In simple words, it is a poor transmission of current something like a state of paralysis.
Bowel or Bladder problems
It is very important as it may be a feature of cauda equine syndrome. It is a medical emergency as it should be urgently managed if you have difficulty in passing urine or stool (constipation) or numbness around the genitalia due to slip or herniated disc.
In young individuals, the soft disc can slip (herniate) due to lifting heavyweight, excessive traveling, excessive bending work or sometimes there may not be any associated factor. In elderly patients disc become hard due to natural aging and due to disc dehydration and thus already has some tendency to bulge but the above precipitating factors can further contribute to the disc herniation. One common point seen in almost all patients is that they have weak back (spinal) muscles and they are unaware of back strengthening exercises. Smoking is also a contributing factor.
The diagnosis of slip disc is made by 3 things:- patient’s history (complains), an examination by a spine specialist and finally an appropriate MRI of the problematic area.
The diagnosis of lumbar disc herniation requires history where the patient complains of low back pain which goes down the leg and that too the backside of the leg i.e.; from hip to the back of thigh and leg/foot (this is classical sciatica pain). While with cervical disc herniation, a patient complains of neck pain which also goes to the arm and hands.
Next, a thorough examination by a spine specialist is done by checking sensations, muscle strength, reflexes, etc. With this much information an experienced specialist doctor can most of the times tell what is likely the cause and where is the slip disc i.e.; whether it is in cervical / dorsal/ lumbar area.
Next, he advises you to undergo MRI investigation for confirmation of the diagnosis, which is again a simple test like any scan and thus does not require any prick or anesthesia. These 3 things (complaints, examination, MRI) when “put together” give surely the further plan of action. This “put together” is actually the most important aspect which decides the correct plan in case of a herniated disc, and it comes with only experience and many years of dedicated practice of the specialist doctor.
Treatment depends on many factors including-
♦ Symptoms experienced by the patient
♦ Age of the patient
♦ The activity level of the patient
♦ Presence of worsening symptoms
Treatment of a herniated disc mostly begins with:
♦ Rest & activity modification
♦ Physical therapy
♦ Medicines: pain killers
♦ Surgery ( if it becomes necessary).
Surgical treatment of a herniated disc may be recommended if a patient has got any one of these:
♦ Significant neurological deficit
♦ Severe pain affecting simple daily activities
♦ Failure of conservative modalities
♦ Significant muscle weakness
♦ Any evidence of cauda equina syndrome
Surgery is performed to free the compressed nerve. Depending on the size and location of the herniated disc, and associated problems (such as spinal stenosis, arthritis, etc) the surgery can be done by several techniques. In many cases nowadays endoscopic surgery, micro lumbar surgery (MISS), stitchless surgery is successfully performed.
Slip disc or herniated disc is the domain of orthopedic surgeon or neurosurgeon? What is the difference?
Actually both can perform this simple surgery. Whoever is properly trained and experienced can perform this surgery. But actually there is some difference. In-country like India most ortho training departments (in medical colleges) get limited exposure or dependent exposure of spine surgeries, but in neuro departments, spinal surgery is the basic part of training and surgery for a herniated disc is very commonly handled independently and is part of the duty.
Only neurosurgeons are trained during residency to perform procedures inside the lining of the spinal canal i.e., inside the dura. Thus, all complicated spine surgeries fall under the domain of the neurosurgeon e.g. spinal cord tumors, arachnoid cysts, syringomyelia, Chiari malformation, spinal cord arteriovenous malformation, diplomyelia or diastematomyelia, tethered spinal cord, spina bifida or myelomeningocele, lipomyelomeningocele, tumors at the junction of the base of the skull and upper cervical spine, nerve root tumors, and a few other diagnoses.
Surgery of herniated disc/slip disc is performed under general or spinal anesthesia. The procedure takes an hour to complete but the actual step of releasing the nerve compression takes approximately 5 – 10 minutes. The exact location of the problem is reached under computerized X-ray machine (C- Arm) so that the site of entry is not only precisely decided but also made a bare minimum. Next, the spinal cord & spinal nerves are totally decompressed by standard simple surgical steps.
This is a newer technique where a surgeon uses special instruments and a camera to free the nerve through a very small opening. The endoscopic microdiscectomy is a procedure that accomplishes the same goal as the traditional open technique but it uses minimal entry excess. Thus there are no external stitches as in any other endoscopic surgery eg: gall bladder or appendix surgery.
Endoscopic surgery is appropriate in some specific situations, but not in all. Moreover, it is also important what your treating surgeon recommends, comfortable and experienced with. While the idea of a faster recovery is nice, it is more important that surgery is properly performed and thus the choice of technique should be totally left upon the discretion of the surgeon and his experience. Discuss with your doctor if endoscopic microdiscectomy may be appropriately performed and how comfortable he is doing that.
Not all neck pain need surgery. For cervical slip disc / herniation / stenosis the rules are similar to lumbar spine i.e., if you have severe neck pain along with pain going into the arm (also hands in some patients) and spine doctor also confirms features of slip disc then it is certain that you need an MRI to confirm that you have a cervical slip disc or herniated/prolapsed disc. If you have features like unbearable pain which is affecting normal daily activities and is refractory to other modalities or if you have muscle weakness then surgery is indicated.
Well, spondylosis means degenerative changes in the spine bones due to day to day wear and tear (obviously the type of physical work/lifestyle contributes).
Spondylitis actually means inflammation of the spine, but so commonly used by general people who say spondylitis but actually means spondylosis.
All features like- complaint of patient/findings on checking / etc are almost similar to what has been already explained above in slip disc.
Not significant. Patients are rather happy and totally pain-free after the procedure. Some may at times tell local minimal discomfort which lasts for 4-5 days which is not bothersome as compared to bad pain which patient had before the surgery. Also, this pain is minimal as compared to traditional open surgery.
With most spinal surgeries, patients are up and walking within hours after their procedure (most patients walk within 30 minutes to 2 hours after the procedure). It is no longer necessary, or recommended, that you lie in bed for days or weeks after spine surgery. Increase in energy and activity are signs of recovery. Recovery is faster as compared to open surgery.
Most patients walk immediately and discharged same day evening or very next day after surgery. It is always better to leave the decision of discharge on the patient whenever he/she feels comfortable. It is also seen some patients wish to stay for some more days as they take more time to believe that what was so painful since a long time was actually a matter of hours.
There are definitely some restrictions as after any other surgery; but are very simple and easy to follow. For example, after lumbar surgery, it is taught how to get up from the bed and lie down, not to lift heavyweight, not to sit cross-legged. This is extremely important and explained with a diagrammatic chart and patients are expected to follow this for a few weeks.
Since these types of spine surgeries are made so common, simple and bloodless; thus blood for transfusion purpose is not arranged.
Sure, these exercises may look very simple but actually are the keystone in success for this procedure. These exercises should be done by every person even who is normal and never had any complaint of back pain. This helps in muscle strengthening and thus saves you from getting a similar problem again or helps to avoid this problem even for the first time.
For the first 4-6 weeks, the activity level is limited to walking and normal daily activities. This is actually very satisfying to the patient as he is able to do his daily routine work without pain. After 3 weeks, the patient is taught physical exercises to achieve muscles strengthening and rapid recovery. In 2-3 months, you are expected to be back to normal activities.
There are definitely some restrictions as after any other surgery but are very simple and easy to follow. For example, after lumbar surgery, it is taught how to get up from the bed and lie down, not to lift heavyweight, not to sit cross-legged. This is extremely important and explained with a diagrammatic chart and patients are expected to follow this for a few weeks.
Sure. Successful outcome after surgery is so great that each patient is bound to think that he/she must have taken the decision of surgery much earlier and made life comfortable. In this modern era, it is never seen that patient has a risk of life actually due to spine surgery or patient remains on stretcher or wheelchair lifelong. Thus, surgery is very simple and safe.
A list of huge patient can be seen outside our clinic with names, age, addresses. We have no failures till date (all our patients are aware of this) but the biggest surprise for surgical teams like us is that some patients keep bearing severe pain and later land into paralysis, who could have actually become alright after a simple surgery.
For further knowledge see video testimonials of some of our patients (note: these patients have actually suffered once thus have joined hands with our team to upgrade the knowledge of all general people who want to learn about latest advances; thus shown no restrictions in a declaration of their identity).
Well, if you are a medical patient and covered by health insurance scheme then it is better you check with our team of medical doctors at cashless mediclaim counter. But if you do not have any medical policy then you have to directly contact us at 09881311973 /09890822422 or see us by fixing up an appointment at 020-24273698 (between 9 am to 9 pm IST). The charges (as for all surgeries) are according to the category depending upon how simple or complex surgery is. But the charges for this disc surgery or canal stenosis surgery is the “lowest” amongst all spine surgeries as it comes in lowest category in our hospital as it is simplest and goes for minimal time duration under anaesthesia.