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 OTHER NAMES
Radiculopatía discal
DEFINITION
The slipped disc is an illness in which it departs from the intervertebral disc (pulpy nucleus) it moves towards the nervous root, presses it and produces neurological injuries derived from this injury.
CAUSES
The intervertebral disc is a cartilage placed between the vertebrae of the spine. It has the function of shock absorber of the shock between the vertebral bodies.
The disc can be damaged by traumatism or by diverse degenerative changes. The exit of the pulpy nucleus towards the vertebral channel, across the postero-side fibrous ring (yellow ligament), provokes a tightening of the intervertebral channel, where the nervous root goes out, and as a result there takes place the compression of the nervous root.
If the pressure is weak the sensibility falters, if it is major the function motorboat falters. This is because in the surface the nervous root has the sensitive terminals (by what they are damaged before light pressures), and inside the completions motorboats are, bearing more the soft pressure and there being damaged if the pressure is intense.
SYMPTOMS
- If the injury takes place at level of the cervical vertebrae C5-6 the sixth root is compressed with pain into the forearm and top arm and into the thumb, flaccidity of the muscle of biceps, and reduction of the reflex of the biceps.
- If it is at level of C6-7 there compress the seventh root with pain appearance into the back of the shoulder, back of the arm and into the fingers index and means, with flaccidity of the muscle triceps, and a reduction of the reflex of the triceps.
These symptoms worsen on having coughed or having sneezed. - At lumbar level if the injury is at level of L4-5, there is compressed the root L5 by what sensitive alteration is observed in the side part of the leg, standing back, and three medial fingers of the foot. There falters the back push-up of the foot and of the medial fingers.
- If the injury is at level of L5-S1 there is compressed the root S1 producing the sensitive loss to him in the side parts of the foot and of two extreme fingers of the foot. The position on tiptoe of the foot falters and the push-up to plant of the foot and fingers also.
In both cases pain takes place in the side parts and later of the thigh.
The pain of these injuries worsens with the cough, sneezes or the lengthening of the sciatic nerve.
DIAGNOSIS
The symptoms and the exploration of the sensibility, mobility and motive reflexes will offer us a perfect map of the possible affected root. For it only we can only confirm the process by means of a RMN (Nuclear Magnetic Resonance) ó a TAC (Axial Scanner Computarizada).
Sometimes it considers to realize a study of the nervous conduction by means of an exploration Electromiográfica.
TREATMENT
The first thing is to try to stop the traumatism continued with an entire rest.
- At level of the neck by means of a ruff, applied many hours a day. Also it is possible to try a haulage of stretching of the neck soft and supported with 10-15 Kg weight during 30 minutes 2 ó 3 times a day.
- At lumbar level it is necessary to raise the entire rest knocked down in bed, mouth it arrives. It is possible to associate the treatment with analgesic and anti-inflammatory or relaxing muscular.
Both treatments must extend for a period from three until four weeks to wait for an entire recovery.
If the picture does not improve debit of a surgical intervention appears.
- The Quimonucleolisis therapy with quimopapaina is in desuetude, the successes were unpredictable and the frequent side effects.
One tends to realize a laminectomía and discectomía like methods of decompression of the root.
This skill is realized by means of general anesthesia. One gains access to the column across the back, there is realized a curettage of the ruptured pulpy nucleus and the plate of the vertebra breaks. Of this one it forms the nervous root remains decompressed on having given him more size to the channel of intervertebral exit of the nerve.
The initial recovery is in 3 or 4 days, to continue in entire rest for a variable period from 2 until 4 weeks.
From this time a few rehabilitation exercises must be begun to obtain an acceptable recovery.
EXPECTATIONS
In most of the cases the backache remains for 1 ó 2 years, the neurological alterations are more been grateful in the short term. If suitable exercises are realized and the movements are controlled well with weight and other activities the almost entire recovery can be obtained in 3 years.
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