Slipped disc

What are spinal discs?

The human body contains 23 discs between each of the vertebrae in the spine. The tough outer part called the annulus fibrosus is made of collagen fibres. This sits around a softer core, known as the nucleus pulposus. The gel-like core aids the spine's mobility while also acting as a shock absorber – for example, taking some of the impact away from when we jump or run. Discs are primarily composed of water, so hydration is key to them functioning properly and remaining healthy.

Discs are categorised as sitting between the vertebrae, which are assigned letters and numbers depending on where in the spine they are. For example, the fourth vertebra in the lumbar spine would be L4; the disc between it and the fifth lumbar vertebra would be referred to as the L4-L5 disc.

The vertebrae and discs in the spine are categorised by their location:

• Cervical spine: The first seven vertebrae, which are in the neck
• Thoracic spine: A group of 12 vertebrae that sit in the chest area
• Lumbar spine: Five vertebrae in your lower back. This is where it's most common to experience a slipped disc. 
• Sacral spine: Five vertebrae that are found below the waist. The tailbone (coccyx) is located here.

What is a slipped disc?

The discs in the spine typically begin to degenerate at a surprisingly early age in many people. It's not uncommon for this process to begin in our 20s. The tough outer part of the disc is most affected by degeneration. It loses its elasticity and strength, so it can bulge or even tear when put under strain.

This process may go completely unnoticed in some people, but if the slipped disc presses on a nerve in the spine, it's likely to cause pain in the back and legs among other symptoms. Types of slipped disc include:

• Bulging disc: Whether through degeneration or an impact through the spine, the annulus fibrosis may be compressed and swell - akin to squeezing a balloon. If this movement interferes with the nerves in your spine, symptoms will likely be felt. The vast majority of cases involving bulging discs will self-heal with a period of modified activity.
• Herniated disc: Also referred to as a prolapsed disc, this condition involves the tough outer wall of the disc being torn and the gel-like core leaking into the spinal canal and interfering with the spinal nerves. Surgery may be required to remove the protruding part of the disc, but many people with this condition are also treated non-surgically. 

The symptoms of a slipped disc may also be referred to as sciatica when it presses on nerves in the lower back and causes leg pain.

What causes a slipped disc?

Discs degenerate naturally throughout our lifetimes and it's extremely unlikely that anyone approaching their 50s or 60s will not have some kind of wear and tear to their discs – whether they experience symptoms or not. Some factors that may lead to an increased risk of a slipped disc, or more intense symptoms, include:

• Excess weight: Putting excess strain on your joints and through your spine increases the pressure on your discs and can make them more liable to bulging or tearing. A poor diet may also accelerate the natural breakdown of the discs. 
• Poor posture: Those who sit for long periods, such as office workers, may be at higher risk of a slipped disc if they do not use ergonomic equipment like chairs with lumbar support as this can regularly interrupt spine's natural curve
• Heavy lifting: Straining the muscles in your back to lift heavy items can cause the discs to bulge and potentially rupture if you're not able to properly lift the weight or do so using poor technique that overloads your spine.
• Trauma: A sudden impact that affects your spine may cause excessive twisting or jolting that can rupture the discs or make them inflamed.

When should I see a specialist for slipped disc treatment?

If a period of rest and conservative treatment has not provided slipped disc relief, our spinal consultants can diagnose your condition – whether it is, in fact, a herniated disc or another issue – and suggest a course of treatment to help you.

Unexplainable tingling and pain in your arms or legs could be a sign of a herniated disc that requires treatment, as can a struggle to stand or walk. Other signs that you might seek help for include a loss of bladder or bowel control; in rare cases, this can be caused by a slipped disc.

Back pain can be caused by a slipped disc. In cases of immobility or severe back pain, emergency treatment at A&E will be the first point of medical help.

If you experience a numb feeling in your genitals, weakness in both legs and loss of bladder and bowel control, you should call 999 or go to A&E right away. These are signs of a rare but serious condition known as cauda equina syndrome. This occurs when the nerves in your lower back become suddenly and severely compressed, requiring emergency treatment. 

Slipped disc diagnosis

A consultant will go through your medical history to check for contributing factors such as ageing, exercise regime, smoking, obesity and heavy lifting. They'll also conduct a physical examination, in which your spine will be gently manipulated into different positions and you'll be asked to report how it feels. 

Tests such as X-rays, CT scans and MRI scans can help to rule out other conditions as well as pinpoint the affected disc.

A discography may also be recommended to ascertain any damage that you have done to your discs. This involves injecting a dye, visible under X-ray, into your disc to see if and how it moves. If you require a discography, you'll be sedated during it.

Slipped disc treatment

Non-surgical slipped disc treatment

The vast majority of people with a slipped disc can treat their symptoms with very minor medical intervention – sometimes even none at all.

• Modify activity: A slipped disc is not a condition that you should "play through the pain" with; this is likely to only exacerbate symptoms and potentially lead to further complications. Stopping any activities that cause symptoms and a period of rest is often all that's needed as a cure for a slipped disc. Gradually increasing your activity afterwards is typically achievable and regularly walking is a great starting point.
• Physiotherapy: A programme of exercises can help strengthen your back muscles or relieve tension in the affected area and ease the pressure on your disc and nerves. Increased blood flow to the area as a result of physiotherapy exercises may also promote recovery and healing.
• Pain medication: Non-steroidal anti-inflammatory drugs such as ibuprofen may help to combat some of the swelling that can cause the symptoms of a herniated disc.
• Steroid treatment: Injections of steroids can act as an anti-inflammatory and may help to relieve the pressure put on the nerves in your spine.

Surgical slipped disc treatment

If your herniated disc becomes very painful and does not respond to non-operative treatment, you may need surgery. In most cases, a portion of the disc is removed with a procedure called a discectomy. Surgery to treat a slipped disc typically involves at least one of the following procedures:

• Laminotomy/Laminectomy: A section of bone is removed from the back of your vertebrae to relieve pressure on the affected nerve
• Discectomy: A section of the slipped disc is removed to relieve pressure on a nerve
• Spinal fusion: Two or more vertebrae are fused together to stabilise and strengthen the spine

When a discectomy is performed in the neck, it's almost always accompanied by the insertion of a cage or artificial disc replacement. In both the neck and lower back, additional metalwork may need to be inserted to give greater stability. Surgery to repair a slipped disc can be done via endoscopy (keyhole surgery), with a small incision made in your back to allow a small camera and specialised surgical equipment to access the affected area. 

We were the first private hospital group in the UK to offer endoscopic spinal surgery. Benefits of keyhole spinal surgery include reduced pain and quicker recovery times.

If you choose to undergo any form of disc surgery, you'll be recommended a bespoke programme of post-operative physiotherapy exercises to restore motion in your spine and relieve stiffness.

How to prevent a slipped disc

• Correct posture: Slouched positions and regularly bending over move your spine out of its natural curvature and place added strain on your discs. Whether sitting, sleeping, exercising or performing work tasks, proper posture can boost your chances of keeping herniated discs and associated symptoms at bay.
• Optimal hydration: As the discs contain an incredibly high water content, they're liable to degenerate quicker if your body is not properly hydrated. If you're dehydrated, the discs shrink and bring your vertebrae closer together. This process, known as desiccation, increases your risk of suffering symptoms such as pain caused by pinched nerves.
• Healthy lifestyle: Regularly exercising keeps your core muscles strong, supporting your spine and helping maintain correct posture. Smoking can quicken the deterioration of your discs, so cutting this out can help. Maintaining a healthy weight for your height and body shape also prevents extra pressure from being put on your joints and spine.