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The bones or vertebrae which comprise the spinal column are joined together by cartilage discs. Each disc consists of a circle of connective tissue with a central jelly-like core.
A slipped disc occurs when the central jelly-like substance bulges out through the circle of connective tissue. This protrusion may press on the spinal cord or on the nerve roots, giving rise to severe pain and restricted movement. However, it is worthwhile noting that over 20% of the Irish population have slipped discs at any one time that they are not even aware of because they are not pressing on the spinal cord or on nerve roots and are, therefore, causing no discomfort.
While slipped discs may occur at any age, a slipped disc in the lumbar region, or lower back, is most common in the 30 to 50 age group, while slipped discs in the cervical region (i.e. in the area of the neck) are most common between the ages of 40 and 60.
A slipped disc can occur for a number of reasons.
As already stated, roughly 20% of the Irish population have slipped discs that they are not even aware of, so very often a slipped disc can be symptom free. If a slipped disc causes pain it is primarily due to pressure on either of three key areas: the nerve roots; the spinal cord or the cauda equina.
If there is nerve root pressure there will be paralysis, or partial paralysis of single muscles. This will be accompanied by pain radiating to the arms or legs, and there may also be a marked disturbance of feeling in the limbs.
If the pressure from a slipped disc is placed on the spinal cord itself there will be a range of symptoms below the point at which the pressure is being placed on the spinal cord. For example, pressure on the spinal cord in the area of the chest will result in spasms or paralysis of the legs, but will not affect the arms.
There may also be an inability to control bladder function in cases where there is pressure on the spinal cord.
Where pressure from a slipped disc is placed on the cauda equina there will be loss of control of bladder and possibly bowel function. There will also be a marked disturbance of feeling in the rectum and the inside of the thighs and there may be paralysis of both legs.
Like many other back problems, your GP will probably be able to make an accurate diagnosis from your medical history and a physical examination, and he may also be able to pinpoint the exact disc which has ‘slipped.’
Since several other diseases have similar symptoms to a slipped disc, the importance of an accurate diagnosis cannot be over-emphasised. Therefore, your GP may refer you for further investigations or for a specialist opinion. Investigations may include a CT scan, MRI-scan or myelography (i.e. an injection into the spinal cord canal).
It is almost universally agreed among the Irish medical profession that slipped discs should be treated conservatively, with surgery being considered only as a last resort and when all other treatments have failed.
The treatment recommended for a slipped disc will usually involve a brief period of bed rest with painkillers, and physiotherapy or chiropractic treatment may also be explored.
If there is evidence of pressure on the spinal cord or on the cauda equina, an operation will probably be performed as soon as possible to relieve the pressure.
In the rare cases where there is severe or increasing paralysis, the patient should be treated as an emergency case and should receive immediate medical assessment in hospital.
Where there are any changes in the symptoms, particularly if there are significant changes in bladder or bowel control or increasing paralysis in the limbs, medical treatment should be sought as soon as possible.