Slipped Intervertebral Disc - Orthopaedics of the Spine - CENTRE FOR ORTHOPAEDICS, SPORTS MEDICINE AND REHABILITATION - Dr. Erich H. Rembeck

Slipped Intervertebral Disc

A slipped intervertebral disc denotes a posterior displacement of an intervertebral disc into the spinal canal. Contact or pressure on the out-branching nerve roots can lead to pain symptoms or neurological deficiency depending on the location of the slipped disc. One distinguishes:

Intervertebral Disc Protrusion

Protrusion of the dorsal intervertebral disc border in the spinal canal.

Prolapsed Disc

Through a degenertion of the intervertebral disc, a tear of the fibrous ring and a discharge of soft intervertebral disc core-material (nucleus pulposus) occurs.

Intervertebral Disc Sequestra

Discharge of intervertebral disc tissue with loss of connection in the disc nucleus.

Depending on the location of the intervertebral slipped disc (cervical spine, thoracic spine, lumbar spine) different treatment options come into question.

Intervertebral Slipped Discs on the Lumbar Spine

In principal conservative as well as operative measures come into question.

Conservative:

Alongside taking medication and physiotherapy exercise treatments, the usage of infiltrative treatments also come into question in the case of persistent pain. This involves image intensifier-controlled, pinpoint rinsing of the affected nerve roots with a local anaesthetic which is mixed with a crystalloid cortisone. The aim of this treatment is a local effective medicinal pain relief. In principal, this treatment can be undertaken many times.

Operative Therapies:

Should conservative therapy lead to no sustained success or if neurological deficiencies exist, an operative relief of the nerve root is also indicated. Here, there are different technical procedures. In most cases a minimal-invasive micro-surgery or a micro-surgery assisted percutaneous technique would be undertaken. With this, a significant reduction in pain is seen immediately after the operation. If pre-operative neurological deficiencies in terms of a sensation of numbness and muscle weakness persist, these can also recede within the course of the post-operative rehabilitation within a scope of weeks or months.

Intervertebral Slipped Discs on the Cervical Spine

With treatment of intervertebral slipped discs on the cervical spine, conservative and operative measures also come into question. The conservative therapy does not differ greatly than that for the lumbar spine (see above). For the operative therapy one must generally distinguish two access paths. In the greater majority of cases the entry occurs from the front due to the localisation of the intervertebral slipped discs. With this, virtually the complete disc will be removed before the actual prolapse is removed and the nerve freed. Following on from this the removed intervertebral disc will be replaced with either a place holder (cage) or with a moveable intervertebral disc prosthesis.

Intervertebral Slipped Discs on the Thoracic Spine

Symptomatic intervertebral slipped discs on the thoracic spine are rare. Should the conservative therapy not bring the anticipated success, depending on the localisation of the intervertebral slipped disc, the possibility exists to remove the prolapse with a micro-surgical entry and to relieve the nerve.