User talk:Painindia

Slipped disc and non-operative interventions
The inter-vertebral discs are protective cushion-like pads between the two vertebrae of the spine. These discs are soft jelly filled pads bounded by few layers of membrane. Just behind the discs there is spinal cord and nerves originating from spinal cord to supply different body parts. The discs do not slip, they can rupture. Following this rupture the jelly may come out into the surrounding tissue. The leaking jellylike substance can produce pressure on the spinal cord or on nerve root /roots and cause pain, numbness, muscle weakness. This condition is also known as a herniated disc, ruptured disc, prolapsed disc, or, slipped disc. The most frequently affected area is the low back, but any disc can rupture, including those in the neck or mid back. When the discs of low back are ruptured there will be pain in low back that will radiate to the legs. Similarly in case of neck there will be pain in neck that will be radiating to the hands. The nature of the pain is frequently electric shock-like pain or burning pain. This pain may be associated with some numbness, tingling sensations and sometime some muscle weakness. As there are so many discs in the spine, the exact area of pain depends on the nerve root involved and that again depends on the disc that is involved.

Sciatica is a frequently used term both by doctors and by patients. It is a symptom and not a disease. Sciatica is defined as any pain that is starting in the low back and is going towards the legs. Sciatica is a non-specific term like fever. Like many diseases may produce fever, many diseases may be the cause of sciatica. Slipped disc is one of the most common cause of sciatica.

Apart from conservative therapy comprising of drugs and different form of physical therapy all other forms of treatment aim at decompressing the nerve roots. These can be done by taking the disc out by surgery or by decompressing the nerve root and spinal cord by different interventions. The various treatment options have confused clinicians due to significant failure rate associated with different kinds of surgeries or interventions Following lumber disc surgeries success rate varies between 49% to 95% and re-operation after lumber disc surgeries varies from 4% to 15%. This is called failed back surgery syndrome. Reasons for this failure are: 1)dural fibrosis, 2)arachnoidal adhesions, 3)muscle & fascial fibrosis 4) mechanical instability resulting from the partial removal of bony and ligamentous structures required for surgical exposure and decompression 5) presence of neuropathy and 6) facet joint arthropathy.

There has been surge of interest in search of safer alternative method of decompressing the nerve roots maintaining the structural stability. Epidural steroid injection and transforaminal epidural block have high success rate (up to 85%) but there is chances of recurrences. Chemonucleolysis using chymopapain has also high success rate (80%) with low recurrences but not popular owing to its side effect profile. Injection of ozone for slipped disc or discogenic radiculopathy (low back pain with radiation to legs) has developed as an alternative to chemonucleolysis and disc surgery owing to its high success rate, less invasiveness, fewer chances of recurrences and remarkably fewer side effects. This is called Ozone Nucleolysis or ozonucleolysis or ozone discectomy. Percutaneous discectomy is another less invasive procedure where disc material is taken out with motorized probe that is introduced through a 17 G needle.

These non-operative interventions have revolutionized the treatment of slipped disc. There is quick recovery, less hospital stay, more economical, very little chance of side effects, and no chance of failed back surgery syndrome- the most fearsome complication of open surgery.