Central Lumbar Disc Herniation
Protrusion of a Disc into the Spinal Canal is a Surgical Emergency
Aug 5, 2008
Spinal discs don’t ‘slip’ but they do herniate or prolapse. This means that a small fragment of the disc, or some of the jelly-like substance contained within it, protrudes into the areas adjacent to the spine.
More often than not when this happens the disc protrudes sideways where it can impinge on the nerve roots that leave the spine. The most common place for this to happen is in the lower lumber spine where the roots of the sciatic nerve can be affected giving rise to sciatica.
This produces pain down one leg, usually to the foot often with associated tingling or numbness in the toes. It’s an extremely unpleasant condition but usually responds to simple manual treatment and gentle exercise. Quite often it will go away in time of its own accord.
If the disc happens to herniate backwards into the spinal canal, which is quite rare, then the situation is radically different.
Clinical Features of Central Prolapse.
The onset is usually sudden, in contrast to other diseases which affect the spinal cord such as multiple sclerosis where the appearance is normally gradual.
- Pain: pain down both legs at the same time is highly suspicious of a central prolapse however pain is not always present.
- Numbness or tingling: again, if affecting both feet and legs it is suggestive of pressure on the cauda equina (the nerves extending down the spinal canal from the end of the cord).
- Loss of power in legs: sudden loss of power in both legs suggests impingement of the cauda equina.
- Saddle anaesthesia: if this is sudden it almost always points to a central prolapse. The area around the genitals and anus is numb.
- Disturbance of bowel and bladder function: there can be difficulty in passing urine or inability to control it. The same applies to the bowel: the dysfunction can go either way. Suggestive of marked pressure on the nerves controlling the bowel and bladder.
- Sexual dysfunction: in men, the inability to produce an erection.
Consequences of Central Prolapse
These can be very serious indeed. Unless treatment is given very quickly any deficits which occur may not return. These could be loss of use of the legs, loss of control of bowel and or bladder and being unable to get an erection.
Treatment of Central Prolapse
Diagnosis is confirmed by CT or MRI scan. Immediate surgical decompression of the affected nerves in the spinal canal is imperative.
This article is for information only. If you have any health concerns you should consult a doctor.
