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Treatment of disc prolapse

Monday, 26 August 2002
Answered by: S.K. Pandya
Neurosurgeon
Jaslok Hospital & Research Centre
Mumbai
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Q. When I was 18 years I was diagnosed disc prolapse of L4-L5 on the right side and advised to go for surgery. Another doctor advised me complete bed rest and after taking bed rest for 15 days I became normal. After two years I again had sciatica pain which was relieved by rest. Last month on 19th, I slipped on steps. After that I had severe pain in centre of buttock but less pain on thighs and calf muscles. I had severe problem in walking for more than 2-3 mins. My posture itself changed with a tilt to left. I took treatment from a local orthopaedician. His observations is pain at L5-S1. X-ray: lumbar spine spasm ++, total loss of lumbar lordosis. I still have problem in walking. I am able to lift my legs etc. but there is more pain on buttock and less on thigh and calf muscles, ankle.I consulted specialists from Pune and was advised to go for MRI scan. His clinical findings are: Left sciatica ++, SLR right 15deg cross +ve, SLR left 30 deg +ve, reflexes- ankle diminished. He is more inclined towards surgery but I am not interested in surgery. Then I consulted another doctor who had seen me two years back. He asked me to continue walking as it was okay. He advised 7 days strict bed rest. I have purchased a traction kit and am taking traction in the morning and evening for 1 hour. After applying ayurvedic oil for joint pain I am using infrared lamp for 10-15 mins 3 times a day. Already 5 days are over. I have improved but in the morning when I get up I have severe pain on buttock (left side); no pain on right side. I have not tried walking. My questions are: 1. Can the disc prolapse shift from right side to left? 2. Can I continue the traction for one hour in the morning and then in the evening? 3. How safe is surgery and do I require it? 4. What are the alternatives to surgery? 5. How to increase the disc fluid? Are there any medicines? 6. Will taking bed rest for 1 more week help? 7. Can I continue using Infrared lamp?

A.  You have not told us the basis for the diagnosis of prolapsed disc when you were 18 years old. Was a myelogram or a magnetic resonance scan done?Fortunately, your pain resolved under non-operative therapy. The later pain appears to have been sparked off when you slipped. Did you actually fall down? Did you then hurt your back? If you did fall and land on your bottom, hurting your lower back, you could have set off a further backward bulge of the intervertebral disc, this time on the opposite side. Since you experience improvement on traction, infra-red light and Ayurvedic oil, it is best to continue these. Coming to your specific queries: 1. The present injury might have caused a fresh bulge on the left. 2. Since the traction is doing you good, it is appropriate to continue it. 3. If your pain resolves with the simple forms of treatment currently being used, surgery may not be necessary. An operation need be considered only if your pain persists, is troublesome and is associated with evidence of compression of the nerves in the spinal canal severe enough to cause weakness of muscles, loss of sensations, difficulty in passing urine - stools, or abnormalities of reflexes in the lower limbs. Performed by an expert, such surgery is safe and effective. 4. There are no drugs that I know of that can restore elasticity to a degenerated disc. 5. See answer 2 above.

A.  You have not told us the basis for the diagnosis of prolapsed disc when you were 18 years old. Was a myelogram or a magnetic resonance scan done?Fortunately, your pain resolved under non-operative therapy. The later pain appears to have been sparked off when you slipped. Did you actually fall down? Did you then hurt your back? If you did fall and land on your bottom, hurting your lower back, you could have set off a further backward bulge of the intervertebral disc, this time on the opposite side. Since you experience improvement on traction, infra-red light and Ayurvedic oil, it is best to continue these. Coming to your specific queries: 1. The present injury might have caused a fresh bulge on the left. 2. Since the traction is doing you good, it is appropriate to continue it. 3. If your pain resolves with the simple forms of treatment currently being used, surgery may not be necessary. An operation need be considered only if your pain persists, is troublesome and is associated with evidence of compression of the nerves in the spinal canal severe enough to cause weakness of muscles, loss of sensations, difficulty in passing urine - stools, or abnormalities of reflexes in the lower limbs. Performed by an expert, such surgery is safe and effective. 4. There are no drugs that I know of that can restore elasticity to a degenerated disc. 5. See answer 2 above.

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