The term PIVD /prolapsed intervertebral disc means the protrusion or extrusion of the nucleus pulposus through a rent in the annulus fibrosus. It has a four stages- Bulging- At this early stage, the disc is stretched and doesn't completely return to its normal shape when pressure is relieved. It retains a slight bulge at one side of the disc. Some of the inner disc fibres could be torn and the soft jelly ( nucleus pulposus ) is spiling outwards into the disc fibres but not out of the disc. Protrusion- At this stage, the bulge is very prominent and the soft jelly centre has spilled out to the inner edge of the outer fibres, barely held in by the remaining disc fibres. Extrusion- In the case of a herniated spinal disc, the soft jelly has completely spilled out of the disc and now protruding out of the disc fibres. Sequestration- Here some of the jelly material is breaking off away from the disc into the surrounding area. prolapsed disc (commonly called a 'slipped disc'), a disc does not actually 'slip'. What happens is that part of the inner softer part of the disc (the nucleus pulposus) bulges out (herniates) through a weakness in the outer part of the disc. A PIVD /prolapsed disc is sometimes called a herniated disc. The bulging disc may press on nearby structures such as a nerve coming from the spinal cord. Some inflammation also develops around the prolapsed part of the disc. Any disc in the spine can prolapse. However, most prolapsed discs occur in the lumbar part of the spine (lower back). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.
Heavy manual labour Repetitive lifting and twisting Postural stress obesity Poor and inadequate strength of the trunk Sitting for long hours increasing age (a disc is more likely to develop a weakness with increasing age)
Lower Back /Lumbar Herniated Disc Symptoms Severe low-back pain Pain radiating to the buttocks, legs, and feet Pain made worse with coughing, straining or laughing Muscle spasm Tingling or numbness in legs or feet Muscle weakness or atrophy in later stages Loss of bladder or bowel control in case of cauda equina syndrome Some people do not have symptoms of PIVD Research studies where routine back scans have been done on a large number of people have shown that some people have a PIVD without any symptoms. It is thought that symptoms mainly occur if the prolapse causes pressure or irritation of a nerve. This does not happen in all cases. Some prolapses may be small, or occur away from the nerves and cause minor, or no symptoms. Neck /Cervical Herniated Disc Symptoms Arm muscle weakness Deep pain near or over the shoulder blades on the affected side Increased pain when bending the neck or turning head to the side Pain made worse with coughing, straining or laughing Neck pain, especially in the back and sides along with spasm Burning pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest Tingling (a "pins-and-needles" sensation) or numbness in one arm
Conservative Management- a) Rest: Rest and Anti-inflammatory and analgesics. b) Reduction: Continue bed rest and traction for 2 weeks may reduce the herniation in over 90% cases. If no improvement with rest and traction, epidural injection of corticosteroid and local anaesthetic are given. c) Chemonucleolysis: dissolution of the Nucleus Pulposus by percutaneous injection of a proteolytic enzyme (chymopapain). This enzyme has the property of dissolving fibrous and cartilaginous tissue.