Dr. Pranjal Pandey
Lumbar PIVD Treatment in Delhi
MBBS, MS (General Surgery), M.Ch. Neurosurgery. A neurosurgeon with over 10 Yrs. years of experience Awarded as the best resident in Neurosurgery and was a regional & zonal winner at TYSA neurosurgery.
UNDERSTANDING LUMBAR PIVD
Lumbar prolapsed intervertebral disc, commonly referred as lumbar PIVD, is an often-quoted diagnosis on OPD prescriptions and radiology reports. The name may itself invoke a complex picture of biomechanical parts at play, but underlying concepts are easy to understand.
The entire spinal column consists of a stack of vertebra that comprises the bony vertebral column. Each vertebral body in the stack is supported on each other by a soft structure called the intervertebral discs. The discs can be visualized as a doughnut shaped cushion (annulus) with jelly like material filled within the cushion (nucleus pulposus). As all movements occur on spine, these discs support the vertebral bodies over each other and allow shock absorption and stability. Now consider if pressure increases over the doughnut (disc), its wall (annulus) may weaken over time and bulge out and, in extreme cases, a part of jelly (nucleus pulposus) may leak out as well. This disc bulge or leakage of jelly like material may give to symptoms to a patient.
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HOW PIVD CAUSES SYMPTOMS
- MECHANICAL PINCH – Bulging discs or leaked jelly like material may cause mechanical compression over nearby traversing nerve roots. In a closed compartment with soft tissue and traversing delicate nerves, any additional disc bulge or extrusion can potentially compress the neural structures, resulting in the symptom
- CHEMICHAL IRRITATION – Leaked jelly like material or nucleus pulposus is an irritant. Pain inducing chemicals induce nociceptive response by causing inflammation of the nearby nerves, causing pain.
SITE OF SYMPTOMS
Lumbar refers to lower back and so the site of symptoms is generally the lower back. As the nerve roots travel and innervate various parts of lower limb, the pain may be felt travelling to lower limb too.
- Pain may be localized to lower back causing a low backache, often exacerbated by bending forward or sideways.
- Sciatica, which means an electric shock like sensation travelling along the thighs to the calf or foot.
- Weakness of the limb or a part of it causing difficulty in moving the limb. It may or may not be accompanied by positive symptoms like burning or pins and needles sensation or negative symptoms such as numbness.
WHEN SHOULD I CONSIDER SURGERY
Vast majority of cases do not require any surgery and may be managed with a combination of rest, physiotherapy, over the counter analgesics or anti-inflammatory medications. Surgical decompression may be required in cases where
- Severe or recurrent pain is not adequately relieved by medications
- Weakness occurs in one or group of muscles in lower limbs.
- Sensation becomes altered in the perianal area or it becomes numb.
- Bladder or bowel control starts getting impaired.