Prolapsed Intervertebral Disc (PID)(Lower back)

Also known as a "slipped disc", prolapse of a disc happens when so much pressure is put on the disc that the gelatinous centre bursts out of the coating. This protrusion may then press on one of the nerves leaving the spinal cord and running just behind the disc, causing the nerve to become numb or send pain signals to the brain. The most common place for a prolapsed disc to occur is in the lumbar (lower back) region although it may occur in the cervical region (neck) or, less commonly, in other places down the spine.

Main points of diagnosis:

1) Most patients have a history of chronic injury in the lumbar region.

2) The symptoms and signs include lumbago with pains radiating to the lower extremity or with pains and numbness in both lower extremities.

3) Exacerbation of the pains in increasing the abdominal pressure, or coughing and so on.

4) Tenderness and radiating pains about the interspinal region; pathological deviation of two or three spinous processes; cord-like, stripping and sliding sensation with tenderness in the supraspinal ligaments above and below the affected vertebrae; unequal widths of the interspinal spaces above and blow the affected vertebrae.

5) Positive straight-leg-raising and intensive straight-leg-raising tests.

6) Positive results of supine-position abdomen-raising test, Queckenstedt’ test, neck-raising and chest-pressing tests.

7) Attenuated myodynamia on the affected side in toe dorsal extension test, hyperalgesia at early stage and hypoalgeia afterwards.

8) Lumbar muscle spasm, deformity and limited activity of the spine.

9) X-ray signs: scoliosis, loss of lordosis, narrowed intervertebral space, hyperplasia of vertebral edge and so on.

10) CT or MRI signs: clear findings of the site, size and shape of the intervertebral disc hernia and the displacement or compression of the nerve root and the durra mater cyst.

Treatment principle:

1) For acute cases: Restore and treat injured soft tissues and reduce dislocation of joints.

2) For chronic cases: Promote the circulation of Qi and blood, regulate the balance of the back muscle, tonic the kidney to strengthen the back.

Postoperative management:

After the manipulation at the acute stage, the patient should take a bed rest, avoid off-bed exercises as much as possible, and continue the acupuncture and TuiNa.

Points for attention:

Acupuncture and TuiNa therapy are the best conservative treatments for this problem. The serious pains can be relieved immediately after the manipulation for some cases, but some patients need more visits to stop the pain. And some cases also require herbs to help recovery and to stop the pain. The treatment will be applied once every day or every other day for the patients of the acute stage. When the pain eases or gets to the chronic stage, the treatment will be applied once or twice a week.