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Science
CASE NOTES
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Tuesday 21:00-21:30
Repeat Wednesday 16:30
Dr Mark Porter gives listeners the low-down on what the medical profession does and doesn't know. Each week an expert in the studio tackles a particular topic and there are reports from around the UK on the health of the nation - and the NHS.
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LISTEN AGAINListen 30 min
Listen to 27 May
PRESENTER
DR MARK PORTER
Dr Mark Porter
PROGRAMME DETAILS
Tuesday 27 May 2008
An x-ray of a skeleton with a bad back

Full programme transcript >>

Backs - Slipped Discs

This week Dr Mark Porter unexpectedly turns patient as he finds out about “slipped discs” – the painful way.

Four months ago Mark hurt his back washing his car, and instead of gradually getting better over the next 6 weeks – as most slipped discs do – his back got progressively worse.

By the tenth week he had pins and needles down his left leg and was having difficulty walking. Referred to a specialist, he was advised to have surgery.

Radio 4 was there – from Mark’s initial consultation to the delicate operation that has now restored him to his former agile self.

At Frenchay Hospital in Bristol, Neurosurgeon Professor Steven Gill explains every intricate manoeuvre.

The Lumber Vertebrae

The spine is made up of vertebrae and between these are cartilage discs. Those in the lower back are called the Lumber Vertebrae and it was here that Mark had incurred damage.

Discs are immensely strong and allow mobility in the spine. They are made up of fibrous tissue arranged in layers and in the middle there is a jelly-like material that is incompressible and acts as the weight-bearing structure in the disc.

As we get older our discs weaken, allowing the soft material to bulge and press on the nerves going down the spine.

Warning signs

Most people with slipped discs will get better without surgery and they generally settle, or start to settle, within the first six weeks.

If the pain, pins and needles, or weakness starts to affect both legs - or you are having difficulty controlling your bowels or bladder – that suggests more worrying nerve compression and constitutes a medical emergency. Contact your doctor immediately.

And if your symptoms have not improved by six weeks then ask your GP for a referral to a specialist who can arrange an MRI scan to confirm what is going on. Mark was advised he needed an operation.

Surgery
The operation that Mark has is called a Microdiscectomy. This involves opening the spine to remove the disc that’s squeezing the nerve root.

It’s done via an operating microscope through a tiny incision in the back and takes about an hour and a half.

Microdiscectomy is now the standard treatment for the minority of slipped discs that require surgery because they are not getting better, or because they are causing worrying neurological symptoms.

It’s not only done by neurosurgeons – many orthopaedic surgeons do it too – but whatever their background, the surgeon must have a special interest in spinal work if you are to get the best result.

The Neck

It is also possible to have a slipped disc between the cervical vertebrae in the neck.

Mark talks to neurosurgeon Rodney Laing from Addenbrookes Hospital in Cambridge who has a special interest in this area.

The main difference between the neck and the lower back is that the spinal cord comes down through the neck but doesn't reach to the lumber spine.

If there is spinal cord compression, this causes greater concern as it has potential to do more damage. However, 95% of people still get better without surgery.

Mark talks to Duncan Mackay who had two operations on his neck to relieve arm pain caused by two slipped discs in his neck. He is now symptom-free.

Case Notes returns at the end of July.
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