Slipped Disc

Symptoms and red flags

The usual picture is a bout of low back pain, often after lifting or a sudden twist, followed within days by pain that shoots from the buttock down the back or side of one leg. This leg pain is sciatica. It is often worse when sitting or bending forward, and a cough can make it jump. Tingling or numbness may appear in the calf or the foot, and some patients find that the foot slaps when they walk or that they cannot stand on tiptoe on that side.

A few symptoms need a doctor the same day, because they suggest a large herniation pressing on many nerves at once:

• Numbness in the area you would sit on in a saddle
• Trouble starting or holding urine, or a change in bowel control
• Weakness in both legs, or weakness that is clearly getting worse day by day
• Back pain with fever or unexplained weight loss

Causes and who gets it

Discs lose water and become less springy with age, so the outer ring cracks more easily, and a herniation often follows a small event such as lifting a bucket or bending to pick up a child. Heavy physical work, long hours of driving, smoking and being overweight all raise the risk. A family tendency plays a part, and the problem is common in men and women who sit for long stretches as well as in those who lift for a living.

Slipped discs are most common between thirty and fifty. Older discs are drier and herniate less, but they wear in other ways. Young adults can herniate a disc after sport or a road accident, and the herniation in a young person is often larger and more painful, although it also tends to shrink well with time.

How it is diagnosed

A good history and a careful examination tell Dr. Salman Falak a great deal. The pattern of pain and the area of numbness point to the nerve root involved, and testing the power in the foot and the knee shows whether the nerve is only irritated or is actually weak. He also checks the reflexes and raises the straight leg, a simple test that stretches the nerve.

An MRI scan of the lumbar spine confirms the herniation and shows its level and how hard it presses on the nerve. Plain X-rays do not show discs, although they are useful to check alignment. The level is usually written as L4-L5 or L5-S1, the two lowest discs, and these letters on your report simply name the bones above and below the disc. If you live outside Lahore, send the MRI on WhatsApp first, and the first conversation can happen by video.

Treatment: conservative care first, then the surgical options

Most herniated discs shrink on their own over weeks to months as the body clears the displaced material. Treatment in that period is aimed at comfort and at keeping you moving: medicine for the pain and the nerve, and physiotherapy as the pain eases. Some patients are helped by a nerve root injection under X-ray guidance, which settles the inflammation while the disc shrinks.

Surgery is advised when a fair trial of this care has failed, or sooner if the leg is weak or the red flags above appear. The operation is lumbar disc herniation surgery, also called a microdiscectomy, in which the piece of disc pressing on the nerve is removed through a small incision. Dr. Salman Falak uses minimally invasive spine surgery techniques, under the microscope or with an endoscope, so the muscle damage is small and most patients walk the same day. Fusion with screws is not part of a routine disc operation and is kept for cases with instability.

What recovery looks like

Without surgery, leg pain usually settles over several weeks, though it can take a few months for the last tingling to go. After a microdiscectomy, leg pain is often much better as soon as the patient wakes, because the nerve is free. Patients usually walk on the day of surgery and go home the next day. Office work can often resume within a few weeks, while lifting and long journeys wait for a few weeks more. Numbness that was present before surgery can take longer to fade, and a little soreness around the wound is expected for a short time. A follow-up by video is arranged for patients who have travelled from other cities, so they do not need to return to Lahore just to show the wound.

When to see a neurosurgeon

Back pain alone, with no leg symptoms, can usually be managed by your family doctor or a physiotherapist at first. See a neurosurgeon when leg pain has not settled after a few weeks of medicine, or when there is any numbness or weakness in the foot. Any red flag means the same day. Patients across Punjab can start with a video consultation and come to Lahore only if an operation is needed. Dr. Salman Falak also sees patients in Gujranwala on Fridays and in Phool Nagar on Tuesdays.

Related procedures

The page on lumbar disc herniation surgery explains the microdiscectomy step by step: the anaesthesia, the incision, the hospital stay and the risks. The minimally invasive spine surgery page describes how the same operation is done through a narrow tube or an endoscope and who is suited to it. If your main symptom is leg pain, the sciatica page goes into that side of the problem in more detail.