Disc Prolapse
The disc prolaps (lat. Prolapsus nuclei pulposi, disc prolaps) is a disease of the spine where parts of the intervertebral disc in the spinal nerves or in the spinal cord channel antecede. In comparison with an intervertebral disk protrusion with a prolaps the anulus fibrosus as well as the ulterior longitudinal band is completed torn. The reason for this is mostly an overstraining of already damaged intervertebral discs. At the beginning of the treatment, rest and pain-relieving medication is prescribed by the doctor. In the course of the treatment physiotherapy and gentle sporting activities for building up muscles is necessary and, however, make sense. An immediate disc prolaps operation is only recommended when neurological symptoms occur eg. paralysis, faecal incontinence, urinary incontinence, saddle anaesthesia.
weiter zur Entstehung...
The disc prolapse mostly develops out of an earlier damage to the intervertebral disc (lat. Discus intervertrebralis), which means damage of its fibrous ring tissue (lat. Anulus fibrosus). The so-called mucinous nucleus (lat. Nucleus pulposus) of the intervertebral disc consists of a gelatinous tissue and can take over the function of a hydraulic ball when it comes to any loading or strain. By this hydraulic function a higher mobility of the whole spine and also a high stability is given.
The human spine has 23 vertebral discs. Between the first vertebra (lat. Atlas) – counted from the bottom up and the second vertebra (lat. Axis) is no vertebral disc developed. By this the head has the necessary mobility for nodding and rotating. In addition, the important nerve twigs and the blood supply to the head is concentrating there.
There are different reasons for a disc prolapse: genetic disposition, onesided burdens in the job and/or spare time or a muscular insufficiency (also: insufficiency of the paravertebral musculature which means the musculature lying besides the vertebra). The solely damage to the intervertebral disk due to an accident or an injury has not yet been proofed as a cause and effect chain. If anything, healthy vertebral disk tissue strains together with a bone fragment from the vertebral body. Often a disc prolaps happen also during a pregnancy. Not to forget is the upright gait and the gravitational force. There are many old people aged over 90 that never had any problems with the vertebral disc or the spine during their whole busy and hard-working life. Besides there are children that even had to suffer from a disc prolaps.
Possible reasons for the rapid increase of disc prolapse are in this times physical inactivity and abnormal positioning and ergonomics especially when it comes to office work. Overweight is more or less no risk factor for a disc prolapse because persons having overweight tend to have a distinctive forward bulging due to their belly weight which prevents them, however, from a disc prolaps.
The average age of suffering from a disc prolaps is around 40 years and the most affected vertebral bodies are situatend in the area of the lumbar vertebra. Less often the cervical vertebra and even more less the vertebra of the chest is affected.
zurück zur Definition...
As the so-called weakness of the connective tissue is a primary reason inherited, a disc prolaps can only be prevented to a certain extend eg. by building up muscles and suitable medication (vitamin C, greenlipshell extractive, glucosamine). Also the avoidance of any accident can not always be totally achieved. So each and everyone, however, have the possibility to consequently build up muscles through practicing gymnastics or also body building and sports as well as trying to avoid the lifting of heavy burdens. There are techniques that can be trained to deal with the lifting up of heavy burdens back-saving because the avoidance of such actions is not possible in every job (eg. nursing care). Body building and fitness activities on a regular basis can become a problem for some people because some gyms have less qualified personnel so that the instructions of them are not very helpful.
Worth mentioning are orthopaedic forms of sport eg. swimming, dancing, walking (which means jogging, nordic walking), horse-riding and cycling. However, after a disc prolaps sporting activities like horse-riding or walking (on an asphalted/cemented ground) as well as cross cycling in a strongly flexed position need to be avoided by all means.
weiter zu Symptome...
zurück zur Entstehung...
Symptoms of a disc prolaps are often strong and effluent pain in the legs (called ischialgia), numbness sensation and also paralysis of the legs with a disturbance of reflexes up to a total deficiency of them.
weiter zur Diagnostik...zurück zur Prophylaxe...
A disc problems can show up without any symptom and under some circumstances totally undiagnosed. If a MRT or CT is made with people that have never had any problems with the spine so far in 25 to 28% these healthy people are diagnosed with a disc prolaps. However, by implication one should be careful to talk about the root of evil or even operate it when only an ischiadic irritation has lead to diagnose a disc prolaps. The most common symptoms are violent pain (in the back as well as radiating into the legs in the case of an LWS (lumpar spine) seizure, sometimes also paraesthesia and/or paralysis. This often shows up (in case the lumbar column is affected) by a numbness sensation in the legs and lower legs and a certain disturbance of walking (a feeling of unstableness). Often affected is the musculature that is lifting the legs, the toes or the outside margin of the foot. The pain becomes slightly better if the patient is taking over a relieving posture of the back. A pain reduction in combination with a proceeding paralysis is not a good sign because in this case the sensorial nerves (pain-controlling) fibres are already damaged and the more resilient, motor nerve fibres are now following.
A neurosurgeon, orthopaedic or neurologist can diagnose these symptoms. A diagnose is often made with a supportive imaging techniques. A prompt treatment can minimize deleterious defects (eg. a permanent weakened dorsal flexor of the foot). That is why a medical specialist should be consolidated anyway.
weiter zur Therapie...
zurück zu Symptome...
Conservative treatment (physiotherapy – chiropractic – extension appliances) as well as the more seldom removal of this part of the vertebral disc that is pressing onto the nerve root can be successful when it comes to the relief of the respective nerve roots. Also the so-called minimal-invasive surgery and microsurgical procedures needs to be named in this connection (eg. nucleoplasty). Even more rare there is a stiffening of the neighbouring vertebral body by means of an inserted metal (spinal fusion). If operative measures are necessary in a given case remains controversial: There are estimations saying that 80% of all disc prolaps operations are unnecessary and could be avoided. Here a strict range of indication makes sense. Severe neurological damages that can be diagnosed as a paralysis by means of electromyogram (EMG) – also called the Cauda-equina syndrome – needs to follow by a disc prolaps operation as soon as possible. This operation is also called nucleotomy. Pain therapy by means of an operation is most often very frustrating for the patients.
In Germany alone every year 30.000 operations of the intervertebral disc are taking place. The operation of the vertebral disc is also the most common neurosurgical operation worldwide. At the bottom line there are no significant differences between the treatment results of an vertebral disc operation or other conservative and not operable procedures like acupuncture or medication or physiotherapy. This is a result of a worldwide clinical study carried out with 1.244 patients suffering from vertebral disc problems (Spine Patient Outcome Research (SPORT)). But still there are certain cases that need to be treated by means of an operation.
Principally the reasons for the disc prolaps need to be treated:
False postures, overstraining, weakness of the torso musculature (it is also called “muscular brace”) …. Many hospitals offer so called back training schools and also private organizations offer the same in order to minimize the strain of the spine in the workaday and everyday life (ergonomic lifting, relieving positions, invigoration of the muscles).
Amongst the many therapy methods and diagnostic methods we find the so-called Alexander Technique, Hatha Yoga or the McKenzie Concept.
In Germany alone every year 30.000 operations of the intervertebral disc are taking place. The operation of the vertebral disc is also the most common neurosurgical operation worldwide. At the bottom line there are no significant differences between the treatment results of an vertebral disc operation or other conservative and not operable procedures like acupuncture or medication or physiotherapy. This is a result of a worldwide clinical study carried out with 1.244 patients suffering from vertebral disc problems (Spine Patient Outcome Research (SPORT)). But still there are certain cases that need to be treated by means of an operation.
Principally the reasons for the disc prolaps need to be treated:
False postures, overstraining, weakness of the torso musculature (it is also called “muscular brace”) …. Many hospitals offer so called back training schools and also private organizations offer the same in order to minimize the strain of the spine in the workaday and everyday life (ergonomic lifting, relieving positions, invigoration of the muscles).
Amongst the many therapy methods and diagnostic methods we find the so-called Alexander Technique, Hatha Yoga or the McKenzie Concept.
Acupuncture often shows very good success.
zurück zur Definition
zurück zur Diagnostik...
Department(s)
Links for further information
