Health Tips › Slipped Disc

Pillar of Support

The spine offers support, mobility and flexibility. But with age comes natural degeneration and care must be taken to prevent damage and disability. Consultant Orthopaedic Surgeon Dr Fong Shee Yan tells us more.

More than 80 per cent of the population experiences back pain. How do we know when it is a sign of a more serious condition?

There are several tell-tale warning signs. If the pain lasts beyond two to three weeks. If the pain recurs over a period just like relapsing asthma attacks. Or if the pain keeps getting worse.

In general, 90 per cent of back pain is caused by natural wear and tear of the spine. However, 10 per cent can also be caused by more serious conditions like injury; serious infections; or cancer where the cancer cells start to attack the spine. If you experience any of these symptoms, it’s advisable to consult an orthopaedic surgeon.

Is backache caused by bad posture and sitting at the desk for long periods?

There are many causes of back pain and it is not necessarily due to lifestyle. This means that a sportsman has an equal chance of having back problems as a desk-bound worker.

It helps to understand how the spine works. Basically, the spine is made up of bones called vertebrae which are stacked one on top of the other. In between the vertebrae are discs made up of an outer shell (annulus) and a jelly-like centre (nucleus pulposus) which help cushion the body’s weight on impact and allow the spine to bend.  After about the age of 18, this mobile segment does not regenerate or heal itself. The discs are often the first to wear out as one ages, resulting in back pain.

So is this what we call a slipped disc?

A slipped disc is the end stage of the degeneration of the spine. When the disc is subjected to repeated compressions, bending and rotations, the ‘shell’ of the disc (annulus) starts to tear. This is the first stage of degeneration.

If no effort is made to prevent further damage, the ‘jelly’ inside the disc will slowly start to push its way out. This is when patients will experience the first onset of serious back pain. Once there is a tear, the water inside the nucleus pulposus will leak – just like a punctured car tyre – causing the disc to lose its buoyancy and strength.

A slipped disc (also known as a herniated disc or ruptured disc) is when the annular tear in the disc, subjected to continuous repeated pressure, eventually ruptures. When this happens the nucleus pulposus extrudes out through the tear, which is similar to a tube of toothpaste being squeezed.

What are the symptoms of a slipped disc? How will it affect my life?

Early stages of spine degeneration are characterised by intermittent, lingering backache. At this stage, the patient can still continue with his or her daily activities.

However, as the ‘jelly’ pushes its way out from the ‘shell’, there will be an obvious worsening of this discomfort – the pain gets stronger, more frequent and lasts longer. A ruptured disc in the lower back (lumbar spine) can ‘pinch’ the spinal nerve root causing pain in the legs and buttocks. Numbness and/or weakness may also occur in those areas.

If a disc ruptures in the neck (cervical spine), discomfort will be felt in the shoulders and arms. Further compression of spinal cord in the neck could lead to permanent paralysis.

What are the treatment options? Is surgery necessary?

A proper diagnosis must first be obtained. A clinical examination and tests such as an MRI scan can also help determine the severity of the condition.

For some patients, especially those in the early stages, all that is required is medication which is sometimes used to reduce the inflammation or ease the pain in affected areas. Physiotherapy with targeted treatment like lumbar traction where the spine is stretched to reduce pressure within the damaged discs may also be recommended.

It’s a misconception that surgery is a ‘must’. Microdiscectomy, which involves removing the affected disc, is only performed in serious cases where the ruptured disc is ‘pinching’ and causing irritation to the spinal nerve root and/or spinal cord. The success rate is above 90 per cent if done correctly.

Do exercises like yoga and Pilates help to improve spinal problems like a slipped disc?

These exercises will increase your flexibility. However, they do not prevent back problems and may actually worsen them, especially if you already have a serious spinal condition that you are not aware of.

So try to be more aware of your neck and back.  Do not ignore persistent neck and back pain or wait till things get worse. Your best bet is to see a doctor at an early stage for proper diagnosis and treatment.

Dr Fong Shee Yan is based at Island Orthopaedic Consultants, #01-04, Blk A, Mount Alvernia Medical Centre, Tel: (+65) 6356 0588.