Mrs Goon, a 24 year old active student, suffered a back sprain while boarding a bus few months ago. She had acute back pain and was almost bed-ridden for 3 days and the pain subsided with strong painkillers. Off late, she was having episodic pain radiating down her legs from the buttocks, along with tingling and numbness of the legs especially after walking or exercising.
Mrs Goon consulted a doctor who advised a X-ray of the lumbar spine followed by MRI of the spine and diagnosed his condition as Lumbar Disc Prolapse. She was advised to take some neuropathic pain medications, which worked for some weeks – but when the pain recurred again, she was referred to me.
On examination, I found her toe movements weak and she had sciatic nerve stretch. The MRI showed a large disc material has come out of its place and sitting on the nerves of the legs at the junction with the spine. She was advised immediate microsurgery as any delay would have further weakened the toe and feet muscles.
She woke up from the surgery absolutely pain free and was discharged on the next day evening. She joined her college after 10 days. At one year of follow up, she is symptom free and is following some basic spine care routine.
Lumbar Discs are supporting elastic structures in between the two bones of the spine and act as shock absorber. They become hard with age and tend to become brittle. Unaccustomed heavy work like heavy exercise without supervision causes the disc to come out of their shell and strike the nerves inside the spinal canal. In lumbar region, this causes severe pain in the legs coming down from the buttocks with tingling and numbness of the legs. Left untreated the disc material sitting on the nerve makes it weak resulting in paralysis of the feet (foot drop). Rarely it may cause acute stoppage of urine and stool by pressing on the nerves of the bladder and rectum (cauda equina syndrome).
In the initial stage, rest, some neuropathic pain medications are tried for 6 weeks. If no relief or partial relief or there is urinary symptoms or the amount of disc coming out is very large, then immediate surgery is advised.
Surgery for this condition is to remove the prolapsed disc and free the compressed nerve (discectomy). The surgery may be open, micro or endoscopic depending on the individual case. Pain relief is instantaneous.
Disc surgery is a simple, routine operation, gives a long lasting relief without any risk of life or paralysis of limbs. Earlier the surgery better is the outcome.