The problem with body aches is you normally know where it hurts, but you can only guess what the reason is. This is especially so when you experience backache, a symptom associated with a wide range of problems , including anything from muscle strain, ostearthiritis and problems of the spine.
While all of the above can cause backache, one of the common causes of back pain is a herniated disck, sometimes called a slipped disk or ruotured disk.
A Slipped disk
A herniated disk is a medical term for a condition where the spine experiences the degeneration of, or damage on, its shock absorbers, the soft, spongy disc between the bones that take the brunt of stress on our spine and nerves.
The condition can be caused by gradual, ageing-related degeneration where the dics loses its central fluid, making it less flexible and prone to tearing or rupturing. Sometimes, too much stress ot trauma to the spine can result in herniated disks too.
According to mayoClinic.com herniated disks are most common in the lower (lumbar) spine, but about 10% occur in the neck (cervicalspine).
Herniations in the lumbar spine are most common between 35 and 45 years of age. Cervical disk herniation is more common between 50 and 60 years old.
But, not all who have sliped disks feels the pain. If the affected disk does not press feels the pain. If the affected disk does not press againts one of your nerves, you may only have a slight lower back pain, or nothing at all. But if it presses againt your nerves, it may cause pain, numbness, and weakness in the area that the nerve travels.
Treatment, thus, seeks to alleviate pain and improve the quality of life of people suffering from slipped disks.
Screening for a sliped disk
A review of your medical history and a few simple physical tests may be all it takes to determine whether you have a herniated disk, wrote Dr S. Craig Humphreys and Dr Jason C. Eck in their article, clinical Evaluation and Treatment Option for Herniated Lumbar Disc.
"Usually, about 80% of patients complain of acute lower back pain, or buttock pain on one side with sciatica (rediating pain with or wihtout numbness) of one leg (pain going down the side of the thight and leg, involving the foot), " said Dr Siow Yew Siong, a spine surgeon practising in a malaysia private hospital.
The remaining 20% would have lower back pain with radiation into both buttocks without lower limb (legs) involvement, he added.
"History taking is the most important part of (dianosing the condition), and we can highly suspect a slipped disk from that, especially when the patient is young," said Dr Siow, who observed that there are more cases of slipped disks in those over the age of 30.
For further investigation, a straight-leg-raising-test and cross straight-leg-raising test can be done. In the former, the doctor will raise the symptomatic leg (with pain or numbness) while you are lying down and the latter involves raising the other leg (without symptoms). If these tests cause pain in your leg or back, it may indicate a herniated disk. Further tests like MRI (magnetic resonance imaging) and ICT (computerised tomography) scan may help your doctor confirm the diagnosis or locate the location of the injury.
Conservative treatment still first-line
Fortunately for herniated disks, surgery is not required most of the time to treat the condition.
"In most cases, if a patient's lower back and/or leg pain is going to resolve after a limbar herniated disc, it will do so within about six weeks. While waiting to see if the disc will heal on its own, several conservative treatment options can help reduce the back pain, leg pain and discomfort caused by the herniated disc," wrote spine-health.com in its own Overview of Lumbar Herniated Disc.
"Normally, when patients feel the migration of pain from the leg or foot to the back, it is a sign of improvement (healing)," Dr Siow said.
"We are very lucky as most of our patients can be treated by conservative treatments," said Dr Achim Luth, a consultant orthopaedic surgeon from Germany who performed a nucleoplasty procedure after a short lecture here at a private hospital.
Ninety percent of the time, patients can be helped by (conservative treatment such as) paravertebral injections, epidural injections with cortisone, medication and physiotherapy, he added.
For his patients, Dr Luth gives conservative treatment atry for eight to 10 weeks before more invasive treatment (surgical methods) such as microdiscectomy or nucleoplasty are considered. In his experience, only about 5% to 10% of his patients had needed microdiscectomy because they had severe weakness or loss of function as a result of the herniated disk.
"A microdisctectomy involves burning the tissue to release the pressure from the disk. It may result in scarring and patients may have what we call post0discectomy syndrome (presistent back pain)," he added.
In Dr. Siow's experience, about 70% of patients with slipped disks will recover irrespective of whether treatment is sought. The remaiming 30% will generally suffer from pain if not treated. There is one exception to the practise of the conservative-treatment-first approach, Dr Siow said.
"If the herniation is so severe that the patient is suffering weakness, loss of bowel or urinary control (the Cauda Equina Syndrome), then immediate surgery should be carried out so as to save nerve tissues and prevent irreversible damage."
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