644 Beagle Road (corner of St Bernard Drive), Garsfontein, Pretoria, 0042, South Africa
Dr Hanlie Lottering Medical Practitioner

Tel: 061 408 7987 / 082 805 9057

Email: chirojacques@gmail.com

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In Defence of Inflammation

August 18, 2017

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Oh my goodness! I slipped a DISC!

April 24, 2017

“Mom! Dad has put his back out again!”; “A friend of mine slipped a disc while snagging a 23kg Carp”.

 

 

Sound quite excessive right? (The slipped disc, not the Carp) Let me help dust off the terminology before the weekend’s boasting around the braai.

 

Long story short:

 

Discs unfortunately don’t slip; they bulge, protrude and ultimately tear.

 

Intervertebral discs are your vertebral segment’s shock absorbers.The loading of pressure onto your spine is regulated by these little shocks.

 

Intervertebral discs consist of a gelatinous fibrocartilage material with 3 components:

  • A nucleus pulposis. A central “jelly like” water derived ball which moves around within the Intervertebral disc (IVD) as movement occurs.
     

  • The Annulus Fibrosis. The tough, circular, outer collagen layers forming the bulk of the discs.
     

  • The vertebral endplates. The glue between die Annulus fibrosis and the surrounding vertebral segments and ligaments.
     

Only the superficial portion of an IVD has a good blood and nerve supply.

 

 

 

The deeper parts receive blood supply through diffusion from the nearby endplates and vertebral bone marrow.

 

Thus, less movement and activity decreases the nutrition and quality of the IVD’s. The oomie with the bad back might be sitting more often while fishing, instead of running to fetch a beer.

 

Unfortunately age-related changes of the discs, as well as acute traumatic events my lead to microtrauma at the endplates and tearing of the Annulus fibrosis.

Injury to these discs range from coughing to picking up heavy objects.

 

The most common mechanism of injury consists of bending forward and lifting a 20kg object with the back bent and the knees straight.

 

It is a lot more comfortable to bend down like a giraffe drinking water, but contracting your core musculature while bending your knees avoids injury.

 

Constant muscle spasm on both sides of the spine is a common presentation in disc injuries, as the supporting musculature jump in to relief the pressure on the injured disc.

 

Injury may range from an irritating protrusion of the gel-like nucleus pulposis, causing localised pain into the bum.

To a prolapse of the nucleus, causing pressure onto the neurological system and referring pain towards the knees. To extrusion, or the infamous herniation of the nucleus pulposis, with referral pain towards the ankles and feet. And lastly sequestration of the gel-like nucleus. The nucleus drips out and cause pain and weakness of the lower limbs.

 

A thorough examination, and if severe X-ray radiographs or a MRI scan, are unfortunately necessary to make sure you’re not walking around with a flat tyre.

 

Once the assessment and images have been cleared for serious complications, specific and thorough treatment will have you back to fishing for the big ones in no time!

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