Your spine is one of the most important and complex parts of your body - keeping it healthy is vital if you want to lead an active and pain free life.
Lumbar Disc Herniation (Lower Back)
Also called a 'slipped' disc or a 'disc prolapse', this is a split or a rupture of the fibrous outside section of a spinal disc. When a disc begins to herniate, its soft central fluid pushes against the fibrous outer ring and triggers lower back pain. If the disc then tears, the jelly-like centre breaks out and inflames the spinal nerves, putting pressure on the sciatic nerve which runs down the leg.
General wear and tear
Ageing - flexibility in spinal discs reduces with age so they can tear more easily
Genetics - some people inherit a higher tendency for their discs to tear
Severe pain running down the leg - usually just one leg is affected
Numbness, tingling and weakness in the leg
Physical examination to assess the neck, arms and lower extremities for flexibility, range of motion and other signs that suggest a herniated disc
The majority of herniated discs heal themselves in the first six weeks so conservative treatment can be effective.
Lifestyle changes - such as losing weight and changing working conditions
Injections to help ease arm pain
In many patients, these conservative methods are effective and the pain subsides after a few weeks.
If other treatments have failed and the pain persists, surgery may be needed.
A discectomy removes the bulging disc material that is causing the pressure on the spinal cord or nerves (hence the term decompression surgery). Sometimes the disc is removed entirely and the vertebrae either side are grafted or fused together to restore stability. Alternatively the disc may be replaced it with an artificial one.
This can usually be done in a minimally-invasive way via a small incision. Most patients go home the same day or next day and pain relief is usually immediate.
"I'm lucky to have had the consultation with Mr Rai when I did, as delays could have led to a very different outcome for me. Mr Rai immediately knew the condition I had, prior to the MRI scan, so I consider myself a very fortunate man."
Read case studies >
Mr C, Aged 37
Condition: Lumbar disc herniation (prolapse)
The patient's experience:
"I'd had on-off back pain for eight years. The back of my leg was also painful and I mistakenly assumed this was a badly-healed hamstring injury. I had tried physiotherapy, acupuncture and many prescriptions for painkillers, none of which had helped substantially. Eventually, unable to walk upright, my GP referred me to Mr Rai.
I play sport so was concerned how an operation might affect my ability to move around so I choose to start treatment with an injection to see if this would reduce the swelling first.
But after further consultation I decided to go ahead with surgery after all. This was successful and I was discharged the next day.
For the first three months I did rehabilitation exercises, Pilates and had physiotherapy.
I feared my back pain would stop me being so active. But since the operation I can do anything I want without having to plan around a bad back.
I have resumed my sports training and just completed a 388-mile cycle ride. Although many parts of my body ached, my back wasn't one of them!"
Mr H, Aged 36
Condition: Herniated lumbar disc with 'cauda equina syndrome'
Treatment: Emergency discectomy
Mr Rai's notes:
Mr H was suffering from a condition called' cauda equine syndrome'. This is a surgical emergency and decompression surgery should be carried out with 24 hours to prevent permanent neurological damage. It is usually caused by a large central disc prolapse which cause pressure on the delicate nerves. Failure to relieve the pressure promptly can cause difficultly with control of bladder, bowel and sexual function which is usually irreversible. This gentleman had surgery within 5 hours and made a full recovery.
A large central disc can cause significant pain and alter the posture of a person."
The patient's experience:
"It all started when I played cricket and was in intense pain afterwards. I had sciatic pain down my left leg, my left foot was numb and my lower back hurt.
The pain intensified over the next few weeks and by the time I saw Mr Rai I could only walk a few steps before collapsing in agony. By then I felt numb below the waist and had trouble with bladder and bowel control.
Life was dreadful. I couldn't walk, sit or drive far. My job involved sitting down, but I couldn't concentrate because of the pain. I couldn't do sport any more or play with my daughter.
Mr Rai told me I needed surgery and clearly explained that if the disc wasn't removed might loose the use of my legs and have permanent bowel and bladder damage. Five hours later I was in the operating theatre.
Once the anaesthetic drugs had worn off I still felt numbness in the left leg, buttocks and genital region, but no pain in my legs or back. It took a while to regain feeling and strengthen my back muscles and gain bladder and bowel control again. I had to be patient and work with a physiotherapist twice a week.
Nine weeks after the operation I am still having physiotherapy but I'm 100% better than if I hadn't had the operation.
I'm swimming, cycling, doing things around the home, back driving up to an hour at a time. I can play with my daughter again, as long as it does not involve lifting or twisting my back. I am also back working from home.
Since the operation I've read articles about 'cauda equina' syndrome and how it can be difficult to diagnose because symptoms are similar to sciatica.
I'm lucky to have had the consultation with Mr Rai when I did, as delays could have led to a very different outcome for me. Mr Rai immediately knew the condition I had, prior to the MRI scan, so I consider myself a very fortunate man.
Mrs B, Aged 33
Condition: Lumbar disc herniation
Treatment: Translumbar interbody fusion surgery
The patient's experience:
"I initially met Mr Rai after my disc burst and I had an emergency operation to remove it. I'd been in such severe pain and could barely walk and the operation brought huge relief from my symptoms.
I had regular physiotherapy and did exercises at home. This helped but about eight months later I was still in pain and couldn't stand for long.
Mr Rai told me that it was likely there wasn't enough disc left to do the job it was supposed to do - support my back. I was too young to start taking things easy to I choose to go ahead with the operation he advised to fuse two vertebrae together.
The first hours after surgery were pretty uncomfortable but within a couple of days I was back on my feet and taking short walks up and down the hospital corridors. I spent seven days in hospital, with a further six weeks off work. I returned to work part-time for a couple of weeks, but soon resumed full time.
My quality of life has improved enormously. I now feel like a 33-year-old instead of twice that age! I am back in the gym, and yoga has helped a lot too.
I am so pleased and eternally grateful to Mr Rai and all the hospital staff looked after me."