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Herniated Disc (Slipped Back Disc) in the Elderly

The elderly are prone to various musculoskeletal conditions; a slipped disc is one of these. The human backbone (spine) is made up of 26 bones called vertebrae, which enclose and protect the nerves of the spinal cord. The joints between these vertebrae are occupied by oval discs made up of soft jelly-like centers surrounded by fibrous outer borders – intervertebral (IV) discs. These intervertebral discs are responsible for cushioning and facilitating movements of the vertebrae during daily activities like bending, twisting and jumping.

What is a herniated disc?

A herniated disc, popularly known as a slipped disc, refers to a condition in which the central soft portion of an intervertebral disc protrudes through a break in the fibrous outer border of the disc. A herniated disc is more common in middle-aged people. While the condition and symptoms are largely treatable in these early years, it causes significant discomfort and disability in seniors. Intervertebral discs in the neck (cervical region) and the lower back (lumbar region) regions are most commonly affected.

Herniated Disc Symptoms

The symptoms depend on the region where disc herniation (protrusion) occurs. A herniated disc could compress the nerves in the nearby region and cause inflammation of the nearby soft tissues.

  • A herniated disc may cause pain when it presses on the nearby nerves of the spinal cord. The pain is most often localized to one side of the body and can vary from a mild, dull ache to a severe disabling pain. The pain can also radiate over a wider area depending on the nerves that get affected. For example, pain might also occur in the hips and the legs if the herniated disc in the lumbar region presses on the nerves supplying the lower limbs.
  • There may be tingling or numbness in the affected regions.
  • Muscle spasms, weakness, or paralysis may be associated with herniated discs.
  • Erectile dysfunction and loss of control over bladder and bowels may occur when lumbar discs are affected.

Herniated Disc Causes

Herniated discs are mostly caused by a sudden strenuous activity or contortion (like back injury or  lifting weights). Weak postural muscles in the neck and lower back also contribute to the development of herniated disc. In some cases, congenital defects (present at birth) that affect the size of the vertebral canal could also be responsible for herniated discs. There also appears to be a a genetic link. However, discs degenerate slightly with age and worsen with earlier injury to the disc. Therefore seniors who sustained a back injury earlier in life may suffer more in their later years.

Treatment

Treatment options for herniated discs depend on the severity of the problem. Complete recovery may take several weeks to months. However, a severe disc degeneration may be incurable and symptomatic relief may only be possible with surgery.

  • Rest is recommended in all cases of herniated discs. In mild cases, patients often recover with rest and pain medications.
  • Medications: Non-steroidal anti-inflammatory medicines (NSAIDs) are given to relieve pain caused by injury. Muscle relaxants are given in case of back spasms and narcotic painkillers are given when the pain is severe. Steroid (cortisone) injections into the spinal column may be given for long-term control of severe pain.
  • Physical therapy involves exercises that strengthen the muscles which support the backbone. Physical therapy needs to be followed along with rest and medications.
  • Surgical removal of the exposed part of the herniated disc is the last option if the above mentioned treatments do not work and paralysis is one of the symptoms.

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