DISC, SLIPPED
D
SYMPTOMS AND TREATMENT OF DISC PROLAPSE
A prolapsed disc in the lower back causes
low back pain and, if a sciatic nerve root is
compressed,
sciatica
(pain running down the
backofthe leg from the buttockto the ankle),
sometimes accompanied by numbness and
tingling. Low back pain and sciatica are
usuallyaggravated bycoughing, sneezing,
bending, and sitting for long periods.
Prolonged pressure on the sciatic nerve can
lead to weakness in the muscles ofthe leg.
A prolapsed disc in the neck causes neck
pain and stiffness. If the disc compresses the
root ofa nerve that supplies the arm, there will
be tingling and weakness in that arm and hand.
In rare cases, pressure is exerted on the spinal
cord itself, sometimes leading to paralysis of the
legs and loss of bladder or bowel control.
Before treatment
This MRI scan ofthe
lower back shows a
prolapse ofthe disc
between the fifth
lumbar vertebra and
the first fused
vertebra ofthe
sacrum.
The sections ofthe spine
N o r m a l
p o s i t i o n
o f d i s c
P u l p y i n t e r i o r
p r o t r u d in g
( p r o l a p s e d
p a r t o f d i s c )
C o m p r e s s e d s p i n a l
n e r v e r o o t
( ’
/
|j
VJ?'
w
\
K X
C e r v ic a l
v e r t e b r a e
. T h o r a c ic
v e r t e b r a e
L u m b a r
v e r t e b r a e
- ( d i s c s m o s t
c o m m o n l y
a f f e c t e d )
- S a c r u m
. C o c c y x
Cross-section of a prolapsed disc
The fibrous outer layer ofthe disc is ruptured,
and some of its pulpy interior protrudes and
presses on a spinal nerve root.
TREATMENT
Disc prolapse often responds to analgesics, and special exercises (see
physiotherapy
)
are helpful. Patients are usually advised to be as mobile as
possible. For resting or sleep, they should lie flat on a firm mattress, with the
head supported and the shoulders, hips, and ankles aligned to ease pressure
on the spine. If these measures fail and nerve root compression is causing
muscle weakness, an operation may relieve the pressure (see
discectomy
;
decompression, spinal canal
) .
subsides. In the meantime, painkillers
are often needed. In severe cases, surgi-
cal techniques, such as the removal of
part of the vertebra (see
decompression,
spinal canal
)
or removal of the protrud-
ing material and repair of the disc (see
discectomy
) ,
may be used.
disc, slipped
See
disc prolapse
.
disease
Illness or abnormal functioning of a
body part or parts due to a specific
cause, such as an infection, and identi-
fiable by certain
symptoms
and
signs
.
disease-modifying
antirheumatic drugs
A group of
antirheumatic drugs
,
known
as DMARDs, that are used in the treat-
ment
of
rheumatoid arthritis
.
Certain
antimalarial drugs
,
anticancer drugs
,
and
immunosuppressant drugs
are used for
this purpose. Examples of DMARDs are
sulfasalazine
,
chloroquine
,
methotrexate
,
gold
compounds (for example aurano-
fin), and
penicillamine
.
DMARDs not only improve the symp-
toms and signs of inflammatory joint
disease, but they also slow the course of
the illness. (In contrast,
nonsteroidal anti-
inflammatory drugs
relieve symptoms but
do not alter the progress of the disease.)
Some DMARDs are cytotoxic, w hich
means that they kill rapidly dividing
cells. Gold compounds and penicillam-
ine may impede the
immune system
from
producing specialized proteins called
antibodies (see
antibody
)
that contribute
towards damage to joints. Sulfasalazine
interferes with a variety of inflammatory
processes in the body, and chloroquine
suppresses the effects of arthritis.
In general, DMARDs may need to
be used for several months before the
full effects are felt. For this reason,
many specialists recommend starting
therapy early to prevent or delay the
progression of joint damage. Treatment
with a combination of DMARDs may
be more effective than a single drug,
and may enable lower doses of each
drug to be used, reducing the risk of
adverse effects.
Possible side effects depend on the
drug taken. They include diarrhoea,
rash,
anaemia
(a reduced level of the
oxygen-carrying pigment
haemoglobin
in the blood),
leukopenia
(a low white
blood cell count), and increased sus-
ceptibility to infection. Regular
blood
238
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