Back Pain- Endoscopic Surgery for Slipped Disc

Slipped disc is a common problem, which affects approximately 1% of the population at any given time. It usually affects people between the ages of 30 to 50 years. It is more common in males and frequently occurs in people whose occupation involves frequent bending and lifting.

Disc is cushion like material between the numerous small bones of
the spine column called vertebrae. This gelatinous material is enclosed in a fibrous capsule. Any tear in this capsule predisposes to prolapse of the disc. Prolapse of the disc causes compression of the nerve that lies very close to it. This problem is more common in lower portion of spine called lumbar spine.

The slipped disc typically causes low back pain, which travels to buttock and further down to back of thigh and calf muscles. This leg pain is also called as Sciatica because it radiates along distribution of sciatic nerve. This pain increases on sneezing or straining, walking etc. Pain may be accompanied by numbness or weakness in leg muscles and in severe situations bladder and bowel disturbances.

Slipped disc, is not only cause of backache/leg pain  but many other diseases can cause it like spinal tumor, infection, T.B ,cancer spreading to spine, osteoporosis, arthritis, spinal stenosis, fractures, congenital diseases etc.

We should not forget that even abdominal tumors and infections can also cause backache and leg pain and numbness. The known factor causing backache are lack of exercises and physical fitness, bad posture, smoking, heaving lifting, bending, twisting, prolonged sitting, anxiety, depression, various games like gymnastics, tennis, football etc. and genetic.

In recent years, MRI scanning is becoming available more easily and is the preferred diagnostic test for spinal problems. MRI scan can clearly show the site and amount of disc prolapse and the nerve compression. Majority of patients respond to the non-surgical treatment. Non-surgical treatment is given in the form of bed rest, medicines to reduce pain and swelling. Physiotherapy is gradually started. Surgery is required in 10-20% of patients whose pain persists after conservative treatment or who have paralysis or bladder and bowel dysfunction from beginning.

Now a day, the operation for slipped disc can be performed through a tiny (about 1.5 cms) incision in the back with the help of an endoscope. Patients can go back home in 12-24hr and patients are usually very comfortable after operation and they can start walking or going to toilet same day. They can go back to their work in a few days. Generally people are very scared of spinal surgery because of risk of getting paralyzed, bed ridden or dependent after operation. They would prefer to suffer rather than getting themselves operated and cured. But with modern surgical techniques such complications are extremely rare.

Human spine is made up of 33 bones calls vertebrae and between each two bones is a soft rubber like disc, which is jelly like in the centre and acts as a shock absorber for the spine and also gives flexibility to the spine. In the centre of the spine runs a canal, which contains the spinal cord. Spinal cord is a big nerve coming from the brain and its branches go into hand and legs. These nerves get compressed, when the disk slips back into the spinal canal and the problem of backache and leg pain starts. Besides slip disc other lesions can also press the nerves and because similar symptoms like tumors, infections, deformities etc. hence a proper diagnosis is essential for the treatment.

-DR. SATNAM SINGH CHHABRA
Neuro & Spine Surgeon, Sir Ganga Ram Hospital,
New Delhi