Disc slip

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List of terms related to Disc slip

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Muneeb, MBBS[2] Synonyms and keywords: Intervertebral Disc Displacements; Disc Displacements, Intervertebral; Disc Displacement, Intervertebral; Intervertebral Disk Displacements; Disk Displacements, Intervertebral; Disk Displacement, Intervertebral; Intervertebral Disk Displacement; Disks, Prolapsed; Slipped Disk; Disk Prolapse; Discs, Slipped; Herniated Disks; Slipped Discs; Herniated Disc; Disks, Slipped; Disk, Prolapsed; Prolapsed Disk; Disc, Slipped; Prolapses, Disk; Slipped Disc; Discs, Prolapsed; Discs, Herniated; Prolapsed Discs; Disks, Herniated; Disk, Herniated; Herniated Disk; Prolapse, Disk; Disk Prolapses; Prolapsed Disc; Disc, Herniated; Disc, Prolapsed; Slipped Disks; Disk, Slipped; Herniated Discs; Prolapsed Disks

Historical Perspective

• [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
• In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

• [Disease name] may be classified according to [classification method] into [number] subtypes/groups:

• [group1]
• [group2]
• [group3]

• Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

• The pathogenesis of disc slip is characterized by bulging of nucleus pulposus of the disk through the annulus pulposus. Nucleus pulposus is the central part of the intervertebral disc that contains proteoglycans. Proteoglycans cause water retention, thus nucleus pulposus is responsible for providing cushioning effect to vertebrae. Annulus fibrosis is the peripheral ring surrounding nucleus pulposus that is responsible for keeping nucleus pulposus in the center of the disk. Displaced fragments of nucleus pulposus can then compress the nerve roots passing behind the intervertebral disk space. Several underlying changes have been implicated in the development of slipped discs including decreased water content in nucleus pulposus, increased activity of degradative processes including inflammatory mediators, apoptosis, and matrix metalloproteinase enzyme leading to degeneration of intervertebral discs. Multiple genes have been considered responsible for intervertebral disc slip. It is also documented that axial overburdening of vertebral column may cause disc slip.
• Genes responsible for disc slip include genes coding for matrix metalloproteinases, structural proteins, Vitamin D receptor, apoptosis factors, growth factors.

Causes

Disc slip may be caused by age-related degenerative changes, systemic inflammatory processes, vertebral trauma, sudden vertebral strain, twisted movement of the spine.

Differentiating intervertebral disc slip from other Diseases

• Disc slip must be differentiated from other diseases that cause radicular pain, sensory deficits, and motor weakness, such as:

• Spinal tumors
• Spinal abscess
• Spinal fractures
• Spinal stenosis
• Arthritis

Epidemiology and Demographics

• The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
• In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

• Patients of all age groups may develop [disease name].

• [Disease name] is more commonly observed among patients aged [age range] years old.
• [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

• Males are more commonly affected with intervertebral disc slip than females.

Race

• There is no racial predilection for [disease name].

• [Disease name] usually affects individuals of the [race 1] race.
• [Race 2] individuals are less likely to develop [disease name].

Risk Factors

• Common risk factors in the development of intervertebral disc slip are increasing age, male gender, excessive body weight, smoking, sedentary life style, abrupt increase in physical activity, heavy weight lifting, poor posture, poor nutrition.

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

History and Symptoms

• Symptoms of Intervertebral disc slip depend upon the site and extent of the slipped disc and are present in the are supplied by the compressed nerve. They may include the following:

Lumbar disc slip

• Lower back pain
• electric shock like or sharp pain radiating from buttock to leg(sciatica)
• numbness or tingling in one leg
• lower extremity weakness
• loss of bowel or bladder control
• pain aggravation with walking, standing or sitting

Cervical disc slip

• Neck pain
• pain between shoulder girdles
• pain radiating down the arm to the hand or fingers
• numbness/tingling in the arm or shoulder
• increase in pain with neck movements.

Physical Examination

• Physical examination findings depend upon the nerve root compressed and maybe remarkable for:

• motor weakness of the muscles supplied by that nerve root
• loss of sensation in the dermatome innervated by that nerve
• Absent deep tendon reflexes
• positivestraight leg raise test in lumbar radiculopathy
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory findings associated with intervertebral disc slip.

Electrocardiogram

There are no ECG findings associated with intervertebral disc slip.

X-ray

There are no x-ray findings associated with intervertebral disc slip. However, an x-ray may be helpful in detecting other etiologies causing similar symptoms like fractures, abscesses, tumors, bony spurs etc.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with intervertebral disc slip.

CT scan

CT scan may be helpful in the diagnosis of intervertebral disc slip. Like MRI, CT scan also provides a detailed view of the spinal canal and its contents, thus it can detect disc slip along with its extent and location.Findings on CT scan suggestive of intervertebral disc slip include bulging of intervertebral disc, nerve root compression, and spinal cord compression.

MRI

MRI may be helpful in the diagnosis of intervertebral disc slip, as it is considered the gold standard for the diagnosis of this disorder. MRI has an excellent capacity to visualize all the soft tissues including the spinal cord, and nerve roots thus it can easily detect bulging intervertebral disc and also if there is any compression of nerve root or spinal cord. MRI is also very helpful in ruling out other differentials.

Other Imaging Findings

Myelogram may be helpful in the diagnosis of intervertebral disc slip. It is a modified x-ray technique in which the spinal canal is visualized after injection of a contrast material. It can show if a slipped disk is compressing a nerve root or spinal cord

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].