Why and how Discs Herniate

When some sudden unexpected force is applied on the spine like unguarded sudden awkward bending, this hard fissured disc material, tears the capsule cover and herniates outside its confinement like a toothpaste coming out of its can and irritates the nerve roots and spinal cord behind to produce typical root pain and radicular pain or sciatica. Depending on the extent of herniation, symptoms may be just a simple back pain, radiating pain along the lower limbs and upper limbs, along the particular nerve root affected. In case of large and severe herniation, focal neurological deficit like weakness of muscle or a movement or numbness.

What should I do : Rest for Spine

• No weight bearing on spine, meaning you are allowed to get up for attending toilet needs and other acts like eating. If the body’s weight is not loaded on the spine, there is a good chance that the herniated disc may get back to its place, with reduction of pain.
• Simple pain killers like NSAID’s helps a lot.

When to : consult Doctor ?

• If radiating pain or limb pain is severe and excruciating and prevents you from performing routine activities
• When you experience numbness of feet, leg or finding it difficult to grasp objects or walk.
• If there are symptoms of difficulty in passing urine.

Epilepsy Surgery

The well-established epilepsy surgery programme at our Hospital comprises a multidisciplinary group of health care professionals who specialise in investigation and treatment of epilepsy.

Investigations doctor would like to do:

• A thorough clinical neurological examination to define the particular nerve root affected and quantify the extent of neurological dysfunction.
• MRI scan which will outline the exact nature and extent of herniation.
• X-ray of the spine, to confirm the stability of the spine and state of bone.

Neuropsychology Inpatients

Inpatient referrals are accepted from any neuroscience ward within the hospital and from any health professional involved in the care of the patient.

When surgery is advocated

• When limb pain is more than neck pain or back pain.
• If straight leg raising test elicits pain within 40 degrees.
• MRI should demonstrate a sizeble disc material at the appropriate level corresponding to the nerve root in which pain occurs like L5 or S1 dermatomes
• Failure of absolute bed rest > 5 to 7days.

What surgical Procedure Minimally invasive Spine surgery

• Usually herniated lumbar disc or cervical disc are removed with minimal access spinal surgery employed with various gadgets like spinal endoscopy and microscopy.
• The procedure is performed under General anaesthesia with X-ray guidance. Usually a 1.5- 2cm incision made and the endoscope is inserted and access to disc is easily obtained. No spinal bone is disturbed as the Endoscope travels through normal avenues to the spine. All the herniated free discs are removed and roots made free. Alternatively endoscope is inserted under local anaesthesia also ( Spinal foraminoscopy)
• Usually, the surgery takes 30-40minutes and pain relief is instant and is finished as a day care surgery
• No complications are usually seen and if it is, it is very negligile