Talk:Spinal disc herniation/Archive 1

Contents from old "Slipped disc" article

Moved spondylolisthesis content

I removed info about spondylolisthesis, as this is really a different condition and should be discussed in a separate article.

Solutions?

I, for one, would like to see a section discussing how slipped discs are repaired. -- Serge Issakov 23:52, 6 December 2005 (UTC)

Disk herniation vs spondylolisthesis

I think this article is confusing. It was my understanding that spondylolisthesis is NOT the same as disk herniation (slipped disk).

Spondylolisthesis involves the vertebral body (i.e. bone) moving and compressing the spinal cord or nerve roots that emerge from it. This can be due to fracture of the pars articularis section of the vertebra (spondylolysis), due to congenital deformity, due to neoplasm (tumours metastasising to the spine) or infection (inflammation of vertebrae e.g. in TB, staphylococcal osteomyelitis).

Disk herniation involves the intervertebral disk (i.e. the spongy bit between bones) pushing out onto the spinal cord. This is caused by damage to the annulus fibrosus cartilage ring that surrounds the disk and keeps it in place.

Anyway, those are my thoughts. Let me know what you think before I edit....

EPFNC. Epfnc 11:07, 20 December 2005 (UTC)

Hi EPFNC,

I am a Medical Student who found this page whilst researching a poster presentation on Spondylolisthesis, and found this Wikipedia page very misleading. I would like to contribute in an effort to improve this page for future readers.

I can confirm that Spondylolisthesis and the term 'Slipped Disc' are not the same condidtions. The laymans term 'Slipped Disc' refers to the medical condition of Disc Herniation, where the nucleus pulposa (a vitrious substance which fills the centre of the intervertebral disc, much like the jam in a doughnut) herniates through the annulus fibrosis (the fibrous part of the disc surrounding the nucleus pulposa - the dough of the doughnut) and can cause spinal nerve root compression. This is commonly the cause of Sciatica, when the spinal nerve irritated is one which goes on to contribute the the Sciatic Nerve.

The term Spondylolisthesis refers to a totally separate condidtion, which usually results from the progression of a bi-lateral Spondylolysis (a stress fracture of the pars interarticularis). This involves the slippage of one whole vertebral body forward on the vertebral body below it, usually the L5 body forward on S1 of the sacrum. The slippage is graded I-IV, with grade I being <25% slippage forward, grade II being >25% but less than 50% slippage, and so on. Spondylolisthesis can lead to pain, spasm of the back muscles leading to tight hamstrings, and change in posture. If the slippage is severe enough, such as grade III spondylolisthesis (ie: <50% contact between the two vertebral bodies) paralysis can result due to compression of the cauda equina within the spinal canal.

The more interesting injury is the spondylolysis, the fracture which, if bi-lateral, can lead to spondylolisthesis. Spondylolysis is a stress fracture of the pars interarticularis, and is an overuse injury common in sports which involve hyperextension of the back in combination with rotation and flexion, for example: Cricket (specifically fast bowlers), Gymnastics, Weight-lifting and Football (soccer). It is a common problem in young athletes in these sports, as they are at increased risk as their growth plates have yet to fuse. It most commonly occurs at the L5 vertebra. Incidence is 4-6% in the general population, but varies with ethnicity (as low as <1% in Black Afro-Carribean women, to as high as 50% in Eskimo populations) but incidence is greatly increased by sporting activity.

Symptoms of spondylolysis include localised pain and tenderness in the affected lumbar region, pain on the aggravating activity (ie: during bowling in a game of cricket), and localised anaesthesia and paresthesia (numbness and tingling) which can extend down to the buttocks. The stress fracture can be diagnosed using MRI, with CT used to assess bony detail for determining if the fracture is complete or incomplete, as well as assessment of healing. Treatment is conservative, involving rest from the aggravating activity and stretching and strengthening of back and abdominal muscles. Surgical options do exist, but these should only be considered as an absolute last result.

A good source of basic information, along with some nice illustrations of the concepts, about Spondylolysis and Spondylolisthesis can be found here: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=155&topcategory=Spine

The article gets a few things wrong, but it should highlight the error in considering Spondylolisthsis and 'Slipped Disc' the same thing.

Hopefully this will aid someone in clearing up this page.

G -- 163.1.176.83 04:46, 29 January 2006 (UTC)

I'm a Physical Therapist, and you are both right. Med student has explained it all quite well. Good going! This article is very misleading, and to compound matters it is linked to from spondylolisthesis, retrolisthesis, and herniated disc. It may even be linked to from other words. It seems that a chiropractor (or layman) must have done this, because they are the only ones who often misuse this concept to get patients to believe that they can "push it back" in place, which is nonsense. Even the paragraph mentioning chiropractic contains this misleading nonsense:

"discs tend to return to their normal position with time."

Discs don't move out of position, nor do the extruded contents ever get "sucked in" again. (This was earlier believed until the development of CT scannings, which failed to show this happening.) Discs can get squeezed, stretched, and twisted, all in small degrees. Since they are very strongly "grown together" with the adjacent vertebrae, they can only be separated from a vertebra by a sharp knife. I have done quite a bit of hunting (mostly reindeer and grouse in Greenland), and have done this many times. It takes a sharp knife!

I can accept the idea of very old people who have so degenerated discs that the discs are so dried out and hard as to be capable of "fracture," which would result in disc fragments, but not slippage, and certainly nothing that can be pushed back in place.

There needs to be a major revamping of the links, with this article being a short paragraph explaining how the expression is a very misleading layman's term for a herniated disc, which should be the main article. The other words need their own articles, explaining how they are not herniated discs.

BTW, the frequency of spondylolisthesis in Eskimos is 30-50%, depending on who describes the condition. It was so common that in all the time I worked in Greenland I rarely received a patient with this as the main diagnosis. One simply took it for granted that they often had it. I got pretty good at differentiating stable from unstable ones. Even in this condition, the disc doesn't move or even loosen, but it gets torqued more than is good. This greatly increases the risk of herniation.

Med student, how about working on this? I'm sure you could do a good job!

I have mentioned the misleading image below on this page. It either should get replaced, or explained as a good (and only - I've never seen such an image before!) example of what can't happen. I'm amazed that Hughston allowed this image to be used at all in their material. Now it's here at Wikipedia in two places! -- Fyslee 22:03, 16 March 2006 (UTC)

Herniated Disc

Why does herniated disc get linked to this page? Looking around and googling it seems like 'slipped disc' is just a laymans term for herniation, see http://jointinjuries.blogspot.com/2005/12/ooo-my-lower-back.html and http://www.spineuniverse.com/displayarticle.php/article28.html.

Unfortunately, I was researching herniation so I can't do a rewrite or edit... --220.245.180.134 12:04, 12 January 2006 (UTC)

I agree. This article should be split to into several articles to show the various types of disc problems. --Durin 21:00, 12 January 2006 (UTC)

Image

Where does the image come from? Please email me your answer. See my User page for email. -- Fyslee 22:45, 11 March 2006 (UTC)

The image is anatomically and pathologically misleading and should be removed. It provides a graphic illustration of a very loose expression that is imprecise and misleading. People get the idea that this can actually happen, and I have read chiropractic "patient education" brochures that actually used the expression "slipped disc" to get people to believe that chiropractors could push them back in place, which is nonsense. Discs can't "slip." Degenerated, torn, ripped, herniated, etc., but not slip. Although discs can't "slip," the contents (the nucleus pulposus, which isn't much) can get squeezed out like a little, soft "lump" of toothpaste from a tube. -- Fyslee 20:50, 16 March 2006 (UTC)

Title of article

It's strange that the title of this article is "Slipped disc" when in the very first sentence the article states that this is a misleading misnomer. Why not have "slipped disc" as a redirect to "prolapsed disc" and use the latter term as the title? It's particularly unhelpful and non-encyclopedic to start off an article with an explanation of what the thing in question is *not*, yet this is necessitated by the choice of the popular misnomer as the very title of the article. Before I change it, however, I'd be interested to know whether "splipped disc" is an index/heading term in medical texts. --Danward 18:18, 17 May 2006 (UTC)

Edits to first section of page

I agree with all the comments so far on this Talk page and tried to address the comments referring to confusion in the opening few paragraphs of the page by addressing how the term slipped disc is used, why the terminology is confusing, and how the term slipped disc is most commonly used. I cited my source for this. I am out of time but also agree with the spondy comments and lack of info on treatments, so I will also try to help with edits in these areas. Please post if any of my edits today need further clarifying/fixing. Also posted some interal links by adding a "see also section and cleaned up irrelevant or commercial external links and added links from credible sources.

Surgery

Why are there no mentions of surgery on this page? --Bri 11:35, 5 July 2006 (UTC)

New article to replace this one

• Spinal disc herniation -- Fyslee 21:54, 28 August 2006 (UTC)

Merge

Discuss the suggested merger here.--Steven Fruitsmaak (Reply) 23:01, 28 August 2006 (UTC)