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slipped disk

      Re: slipped disk

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Posted by CCF Neuro MD on July 03, 1997 at 00:18:36:

In Reply to: slipped disk posted by Hazel Dinger on June 25, 1997 at 10:08:56:

: My husband has been diagnosed with a slipped disk.  I wasn't with him at the doctor's office and am getting very sketchy details from him.  How serious is this and what are the options for treatment?  How long will he be out of work?  I know if it ruptures he could be paralyzed, would it be permanent?  Can a Chiropractor help?  I'm really scared for him, when he got out of bed this morning his leg would not support him and he fell.  Can you ease some of my concerns?  Thank you.  Hazel Dinger
Dear Hazel:
Intervertebral discs are a gelatinous structures between the vertebrae or bones of the spinal column. They are under pressure because the spinal column bears the weight of the upper body. Each is surrounded by a dense strong fibrous ring which prevents it from escaping out from between the vertebrae. With age (usually in middle age) the discs undergo degeneration which includes weakening of the ring and drying if the gelatinous structure. In these circumstances minor or major trauma can precipitate a prolapse or slippage of the disc. Although this can occur at almost any level inthe spinal column, the commonest sites are between vertebrae L5 and S1, and between L4 and L5 in the lower back. Also, it tends to occur backwards and to one side. This often results in pinching of one of the nerve roots coming out of the spinal column and resulting in neurological symptoms. Compression of roots at the levels I mentioned tends to cause symptoms in one of the legs. There can be back pain which radiates or shoots down the back or side of the leg, which is often worse with coughing, sneezing or straining. There can be an area of numbness in the foot leg, or less commonly the thigh ir buttock. There can also be weakness of the foot or leg muscles. The degree of slippage of the disc varies from mild to very severe, and this may correlate with the severity of symptoms. Although, as you mentioned, paralysis of one or both legs is possible from a slipped disc, this is usually not the case. The majority of symptomatic slipped discs are relatively mild, and pain is the commonest presentation. The majority of slipped discs in the lower back are managed conservatively commonly with partial bed rest till the patient's pain improves enough to allow him to walk and do other activities relatively comfortably. Surgery is an option, but the indications vary, and so do results or benefits ("failed back" operations abound). Surgery is definitely offered if there severe weakness, and may be considered for intractible pain. The diagnosis of a slipped disc is commonly based on an MRI ofthe spine, and possibly an electrical test called the EMG. The MRI is not infallible in that as many as a quarter to a third of normal or asymptomatic people have significant "slipped discs" visible on the MRI. The MRI has been useful in following the natural history of discs. As many as 60 percent of slipped discs are seen to clear in 6 months.
Treatments other than rest and early activity as tolerated include physical therapy, back exercises, traction and chiropractic manipulation; no treatment has proven efficacy, and some (such as chiropractic manipulation) may occasionally be dangerous if wrongly used.
The fact that your husband fell on attempting to stand up worries me. It suggests significant weakness or sensory deficit. It is not a common symptom with slipped discs. I strongly urge you to take your husband to see a neurologist, if he has not already done so.
In case you live in the Cleveland area, your husband is welcome to see any of the neurologists at the Cleveland Clinic. An appointment can be scheduled by calling up (800)223-2273 or (216)444-2200 and asking for the neurology appointments desk.

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