Intervertebral Disc Pathologies
Intervertebral discs are the cushions which are present in our spine between two vertebrae and allow the spine to be flexible without sacrificing a great deal of strength. There are 23 discs in the human spine: 6 in the cervical region (neck), 12 in the thoracic region (middle back), and 5 in the lumbar region(lower back).
Various disc pathologies which can lead to back pain are :
- Disc degeneration/ Degenerative Disc disease: Disc degeneration is a natural process which occurs in our body as our age increases due to years of stress that disc goes through. However, if this process starts early in life or it leads to development of chronic pain syndromes then it needs to be addressed and managed. Some of the features seen in the spine which can indicate the initiation of degenerative process in the spine are- reduction in disc height, change in curvature of the spine, presence of Schmorl’s nodules or osteophytes in x rays and loss of signal intensity of disc in MRI scans.
- Annular tears: Annulus is the outer tough layer of the disc. Whenever there is tear in this layer, the inner jelly like part of the disc( Nucleus Pulposus) migrates outside the disc causing nerve inflammations , compressions ultimately leading to sciatica like symptoms. Furthermore, there is development of new nerve fibres in the torn area called as neurotization which further aggravate the back Pain. Annular tears can be identified as High intensity zones ( HIZ) in the MRI scans.
- Disc bulge/ Prolapse: Protrusion of disc beyond the posterior margin compressing the nerve roots or the spinal cord. These disc bulges can be central, paracentral, Foraminal, Extra-foraminal according to their location. Identification of the type of disc bulge is important as the treatment protocol varies with the type of bulge.
Signs and Symptoms
- Continuous or intermittent sharp pain in the back which may/ may not be associated with the radiating pain in the legs
- Aggravation of pain on prolonged sitting, walking, forward bending
- Feeling of leg muscle spasms on walking for short distances.
- May be associated with Tingling/ numbness/ burning or weakness in the legs.
Risk Factors
- Prolonged sitting job like driving
- Abnormal posture while working
- Work involving bending and lifting weights
- Inadequate diet or water intake
- Weight bearing sports like weight lifting
- Obesity
- Smoking
JEEVISHA protocol for management Disc pathologies:
If there are no Red flags, the initial management of these patients is always conservative for a period of 3-4 weeks. Conservative management strategies include
- Work ergonomics correction: Changing the Ergonomics at work place plays a very important role in management of these patients. Expert faculty at JEEVISHA analysis the problems and helps the patient bring changes in their daily life.
- Posture correction: With facilities like Posture Analysis machine, the root cause for the development of these painful conditions is identified and patient are trained to overcome this problem in a step wise manner.
- Medications: In the initial course of the management of this condition, patients may be prescribed some Neuropathic medications. Some other medications may be prescribed depending on the condition of the patient, which is individualized from patient to patient basis.
- Physiotherapy: Physiotherapy plays a very important role in fighting these painful conditions. With a team of dedicated physiotherapist, patient is further evaluated and accordingly a plan is prepared for first reducing pain and then focusing on strengthening of the paraspinal muscles.
Targeted treatment:
If conservative treatment fails, various Minimally invasive percutaneous spine Interventions [ MIPSI] are offered to patients according to the severity of their pathology.
Various MIPSI offered are:
- Transforaminal epidural injections
- Disc Biaculoplasty
- Ozone nucleolysis
- Dorsal Root Ganglion Pulsed Radiofrequency ablation
- Endoscopic Discectomy