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By Michelle Kwong

I am diagnosed of slipped disc. Should I go for physiotherapy treatment or surgery in Singapore first?

This is a common back pain problem faced by patient in doubt of their back condition.

What is a spinal disc?

There are many different back problems to a spinal disc: Slipped disc, prolapsed disc, herniated disc, degenerated disc ‘wear and tear’ and disc extrusion. As we all know our vertebral column is made up of bones called vertebrae. Between these vertebrae are discs which help in shock absorption, allows mobility and also provides stability to the vertebral column.

What is slipped disc?

Under normal circumstances the disc stays within its space between the vertebral bodies and does not put pressure on either the nerve root or the spinal cord which runs in the vertebral canal. However when the pressure within the center of this disc increases it can move out of its place, compressing nerve roots and in many cases also the spinal cord, and result in what is called the prolapse disc.

A prolapse disc can cause a variety of symptoms starting from back pain and tingling numbness to sensory loss and weakness on the arms or legs. The severity of the symptoms depends on the compression that the disc is resulting in. In cases where there is a very small displacement of the disc, back pain and leg tingling might be the only symptoms. However if the disc is centrally prolapsed and is compressing the spinal cord there might be a lot of sensory loss and weakness resulting in a lot of disability.

So now that we understand what a prolapse disc is let us discussed about the treatment of a Slipped Disc. Do we choose physiotherapy over surgery or surgery over physiotherapy in Singapore?

The treatment of choice in a prolapse disc depends on the stage of the spine disorder. Most cases of prolapse disc is treated and cured with conservative treatment, which consists of physiotherapy and medications. Physiotherapy treatment for back slipped disc would consist of pain relief equipment by electrical stimulation, ultrasound and manual therapy, stretching of tight muscles, nerve or joint mobilization, strengthening the back and core muscles, and ergonomic advice. Most cases of prolapse disc resolve completely with physiotherapy and if the patient continues taking precautions, maintains an active lifestyle and a strong core muscles, and makes a few lifestyle modification prolapse disc will not relapse.

However there are cases which will not resolve with physiotherapy and requires surgical intervention. These cases are:

— Severe back pain persisent, even after taking conservative treatment for more than 3 to 6 months.

— Neurological deficit with progressive weakness, constant numbness and tingling on arms or legs

— Increasing back pain in spite of being under physiotherapy treatment.

— Unable to perform simple daily activities such as sleeping, sitting, walking

Neurological deficit or progressive neurological deficit is a red flag and should be attended to immediately. Neurological deficit implies that there is a large compression of the nerve roots or the spinal cord, and this needs immediate decompression.

The decision to go in for a surgery in Singapore is to be considered seriously by the patient as this is an invasive irreversible method and not a 100% cure.

Even post decompression surgery, physiotherapy is of utmost importance to strengthen the core muscles and prevent slipped disc at other levels. Also post operation pain can be reduced by physiotherapy. 3 to 6months of rehabilitation with progressive exercises with physiotherapist ensure that the patient can go back to his daily activities without fearing another episode of prolapse.

Most cases of slipped disc will recovered with physiotherapy in Singapore, surgical intervention option will be considered if failed.

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