Most slipped discs are caused by general wear and tear, such as when performing jobs that require constant sitting, squatting or driving.
The majority of cases affect the low back (95% lumbar region either at L4/L5 or L5/S1, with the neck the next most commonly involved region, either C5/C6 or C6/ C7.
A slipped disc usually presents with back or neck pain, with pain travelling down the patient’s leg or arm. The vast majority of slipped discs may be treated by GPs and physiotherapists, with rest, analgesia, non-steroidal anti-inflammatory medication and epidural injection being the mainstay of treatment.
Surgery, in the form of a discectomy or decompression, is reserved for cases which do not resolve with the above management.
Case study: A keen walker, Marie Menzies struggled with back pain for many years. After enduring a particularly bad six months, she was limping and no longer able to keep up with her husband.
“I could not stand the pain any longer. I had pain in my lower back and it was running down my left thigh, which was very intense at times,” she says.
She decided it was time to take action and to seek advice.
Her GPs, Mary Barry and Lynda O’Callaghan of Barryscourt Medical Centre, Carrigtwohill, referred her to the Mater Private emergency department, Cork.
At the emergency department, she was rapidly seen, assessed and scanned by Oisin Powell, emergency department consultant, and his team. She was referred for a MRI scan of her lumbar spine, which showed a large slipped disc in her lumbar spine, at the L3/L4 level.
Dr Powell explained the findings of her scan to her and requested a review with the spine team.
Paul Kiely, consultant spine surgeon, Centre of Spinal Disorders, Mater Private, reviewed her that afternoon in the emergency department.
After taking a detailed history and examination, he outlined the treatment options. This condition can normally be treated non-operatively and operatively, but since Marie had a large slipped disc, and her leg was weak, he explained that her symptoms would be unlikely to resolve with continued non-operative treatment.
While the prospect of surgery was daunting, Marie says she felt Dr Kiely was “so normal, and approachable that put me at ease all the way through the whole process”.
Surgery was deferred initially because she was taking aspirin medication, which needed to be stopped a week prior to her surgical intervention to limit risk of bleeding associated with aspirin use.
After being assessed in the pre-assessment clinic, she was admitted two weeks later for surgery, during which she underwent a L3/L4 discectomy and decompression.
The surgery was successful and uneventful — Marie woke up in the recovery room without any leg pain.
The day after surgery, she was able to stand up and walk a short distance without pain. Two days later, she was walking the corridor without pain or a limp.
Dr Kiely says her recovery was impressive, adding results like this are “tremendously rewarding ”.
Marie’s hospital stay lasted four days with follow-up checks in the clinic.
“I couldn’t lift my left leg before surgery, but I can now do so without any problems. The care delivered by Dr Kiely, his team and Mater Private nurses was top class,” she says.
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