The discs lie between the end surfaces of bones that make up the spine. They have a soft jelly-like centre called nucleus pulposes surrounded by a rigid outer ring called the annulus fibrosis. These discs mainly act as shock absorbers. The spinal cord and nerves lie close to the back of the discs in the spinal canal.

A disc bulge in MRI is seen in most normal people, and they are not significant. But this disc bulge needs to be differentiated from disc prolapse. When the soft jelly (nucleus pulposes) tears out through the rigid outer rim (annulus fibrosis) and comes out and lies in the spinal canal, it becomes significant. When this happens in the lower back, this can compress the nerve roots that go to the legs. This pain is called sciatica. A similar condition can occur in the neck. This causes neck pain with radiating pain to the hands.

Cauda equina syndrome is one of the rare conditions caused by disc prolapse, where it compresses all the nerve roots going down to the legs and urinary bladder. This causes urinary problems like difficulty in passing urine etc.
Myelopathy is another severe problem where a large disc compresses the spinal cord at the neck level. Here patient may express difficulty in walking, holding objects in hand, problems with urination etc. These are the conditions in which surgery needs to be considered at the earliest as the problem recovery becomes difficult.

MRI SHOWING FAR LATERAL DISC PROLAPSE

POST OPERATIVE MRI SHOWING COMPLETE REMOVAL OF DISC

DISC PROLAPSE IN THE NECK CAUSING SEVERE COMPRESSION OF THE EXITING ROOT

 

Surgery is not required in most cases. Often pain subsides with rest and pain killers. If there is no relief, then a short treatment period in hospital as an inpatient usually helps. Surgery is required for those who do not respond.

Surgery helps to relieve leg pain or arm pain. Usually, it can be done as a daycare surgery or a day of admission. The minimally invasive technique is used, which helps faster recovery with early return to work. In most cases, no restriction of activity is required, nor a need for a belt or other assistive devices. There are different techniques used like endoscopic discectomy, micro discectomy, mini-open surgery and conventional discectomy. But the type of technique depends on the type of disc prolapse and patient profile.