Prolapsed Intervertebral Disc

The lumbar disc is comprised of an inner gel and an outer annulus. The lumbar discs provide stability and resiliency to the lumbar spine. Lumbar disc herniation develops because of a tear in the annulus of the lumbar spine; the inner nucleus pulposus extends beyond the tear, comprising a part of the spinal canal.

Prolapsed Intervertebral Disc

In many cases, lumbar disc herniation develops insidiously as a result of repeated, small micro tears that develop in conjunction with a degenerative disc. In these cases, patients with lumbar disc herniation may be completely without symptoms. Indeed, imaging studies have revealed that lumbar disc herniation may be present in a sizable number of individuals who have no symptoms.

Many patients with an acute lumbar disc herniations have symptoms of pain or numbness in conjunction with a pinched or compressed nerve. Acute lumbar disc herniation develops because of a sudden and large tear in the annulus, with subsequent rupture of nucleus pulposus material through the tear. Most of these herniations occur posteriorly, that is, toward the back. They also are generally to one side, but occasionally are midline.

If a disc herniation is initially midline, pain is perceived as a deep discomfort in the center of the lower back. Sometimes patients describe a sudden popping sensation. Other times, the patient senses that something is wrong in the lower back, but the pain may not be excruciating. Over days, the tear may enlarge and the disc herniation worsens while symptoms increase.

As a disc herniation enlarges, it generally does so to the right or left of midline. Often, it will compress the lumbar nerve root at that level. Most disc hernations develop between L4-L5, or L5-S1, which are the two lowest segments of the lumbar spine.

These two levels of the lumbar spine are the most mobile and vulnerable segments.


When a nerve root is compressed, there may be associated pain, and pain will normally be perceived in the sensory distribution of that nerve. For example, a herniated disc at L4-5 may compress either the right or left L5 nerve root, which may cause pain radiating down the right or left side of the leg and into the great toe. IF the nerve is severely compressed, there may be numbness (corresponding to the same sensory distribution) or muscle weakness. This demands urgent medical attention.

Patients with acute lumbar disc herniation typically are comfortable lying on their back with knees flexed. Sitting is often uncomfortable, and standing may or may not be comfortable. Patients generally avoid bending forward, and sudden coughing or sneezing can worsen symptoms.

Cause of Lumbar Disc Herniation

The cause of acute lumbar disc herniation is not always apparent. Patients with chronic, degenerative lumbar discs and associated disc herniations often have a genetic predisposition to such degenerative changes. Otherwise, lumbar disc herniations generally occur in the setting of repeated overuse of the lumbar spine or sudden, more severe overuse. In this case, it is not simply the supporting musculature that gives, but the stabilising force of the lumbar spine itself.

Imaging and Diagnostic Studies

Plain X-rays is more for excluding other causes of back and radiating leg pain.

Magnetic Resonance Imaging (MRI) is the diagnostic study of choice for lumbar disc herniation. MRI is recommended if the doctor suspects a large disc herniation. MRI should be obtained if the lumbar disc herniation that is not improving with nonsurgical treatment over a few weeks.

Treatment Considerations

  • Medicine
  • Physiotherapy
  • Epidural Injection
  • Surgery

Summary Points

  • Lumbar disc herniation often develops gradually because of a genetic predisposition to degenerative disc changes.
  • Sudden lumbar disc herniation can cause severe pain and sometimes causes leg numbness and weakness.
  • Incontinence or severe leg weakness from lumbar disc herniation needs to attend immediately by an orthopaedic surgeon for decompressive spine surgery.
  • Most cases of lumbar disc herniation can be managed nonsurgically; over the long term, most patients can return to full activity.
  • Patients who develop lumbar disc herniation should try to reflect on significant life stressors that may predispose to spine imbalance.

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What is Decompressive Laminectomy for Lumbar Spinal Stenosis?

Decompressive laminectomy is the most common type of back surgery done to treat low back – spinal stenosisLaminectomy is done to relieve pressure on the spinal nerve roots caused by degenerative changes in the spine. It is also done to treat other spine conditions such as, spine injuries, slipped disc, herniated disc or tumours. The aim of the surgery is to reduce the pressure to the nerve roots so as to relieve your pain and allow you to return to your normal daily activities.

Laminectomy removes parts of the bone or thickened tissue that is narrowing the spinal canal or pressing the spinal nerve roots. Laminectomy involves a small incision to the back.

What To Expect After Decompressive Laminectomy

Recovery of the surgery is gradual.

Why Decompressive Laminectomy Is Done

Decompressive laminectomy for lumbar spinal stenosis is considered when:

  • Severe back pain symptoms has affect your day to day activities.
  • Tried all conservative (nonsurgical) treatments but the symptoms persist. Numbness and weakness to the legs gets worse and not getting better.
  • You cannot walk very well.
  • Bladder and bowel control may be affected.

How Well Decompressive Laminectomy Works

The surgery has good results and you will see the result the next day of the operation. The symptoms will be reduced significantly.

What To Think About for Decompressive Laminectomy

You may want to exhaust all nonsurgical treatments before choosing surgery.

One can try the below conservative treatments before proceeding to the surgery.

Call +65 6471 2674 for an appointment to see our orthopaedic surgeon regarding decompressive laminectomy.

You may need to consider surgical intervention for your back problem that is caused by a tumour or infection.

Removal of Spinal Tumours

Spinal tumours are growths found on the bones and ligaments at the spine, the spinal cord or on the nerve roots. The tumours can be benign (noncancerous) or  malignant (cancerous). During the surgery, the surgeon will remove the tumour or any bone that has damaged.

If some parts of the spine is affected by the disease and needs to be removed, the surgeon can use metal implants, bone grafts or bone cement to make your spine stable.

There are certain types of tumours which you can ignore. However, it is important to speak to a doctor to ascertain that the risks involved is minimum. Get advice from a surgeon who is an expert in treating spinal tumours.

Debridement of the Spine

This surgery is usually recommended for patient who has infection or injury to the spine. Debridement of the spine involves removing parts of the bone or other soft tissues that are infected.

The surgeon will remove the infected and damaged dead bone. The area is then cleaned with sterile solution that contains antibiotics. If the spine is severely affected and requires to remove a lot of the bones or entire vertebrae, he or she may use the spinal fusion (arthrodesis) method to stabilise the spine.

Call +65 6471 2674 for an appointment to see our orthopaedic surgeon to discuss the spine surgery today.

Knee Replacement X-ray

Arthroplasty is a surgical procedure done to reconstruct or replace a diseased joint. Arthroplasty for rheumatoid arthritis is done to correct the deformity or restore the function to the joint. Bones in a joint can be replaced with metal or plastic parts.

Knee Replacement X-ray

What To Expect After Arthroplasty for Rheumatoid Arthritis

Recovery after arthroplasty is gradual. You may need to stay in the hospital for 2 days and the next day after the surgery, you will be able to walk with the help of walking aids. Depending on the the joint operated, post operative rehabilitation program will take a few weeks.

Why Arthroplasty for Rheumatoid Arthritis Is Done

Arthroplasty for rheumatoid arthritis will provide pain relief and improve the range of movement of the joint to a certain extent.

Arthroplasty for rheumatoid arthritis is considered when:

  • Symptoms can no longer be controlled with medicine, joint injections, physical therapy, and exercise.
  • Pain from rheumatoid arthritis can no longer be tolerated.
  • You are not able to do normal daily activities.
  • Narrowing of the joint space or wearing away of the cartilage and bone is causing severe pain or reduced range of motion.

How Well Arthroplasty Works for Rheumatoid Arthritis

Arthroplasty can help in reducing the pain and restore  the function of the joint to allow you to resume to your normal activities.

What are the Risks of Arthrosplasty

The risks of arthroplasty include risks of a surgery and anaesthesia, the risks are small:

  • Infection
  • Loose joints

What To Think About For Arthroplasty For Rheumatoid Arthritis

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An important factor to the success of arthroplasty also depends on the person’s commitment to post operative rehabilitation.

Call +65 6471 2674 (24 hr) for an appointment to see our orthopaedic surgeon to discuss arthroplasty for rheumatoid arthritis.

Knee arthroscopy external view

Arthroscopy is a keyhole surgery whereby a mini camera is inserted into the joint through small cuts in the skin, allowing the surgeon to see the inside of the joint. Instruments are inserted through other small incision to repair the joint. Arthroscopy for rheumatoid arthritis can help to improve the symptoms to much extent, but it does not cure the underlying rheumatoid arthritis condition.

Knee arthroscopy external view

What To Expect After Arthroscopy?

Arthroscopy is usually done as a day surgery, there is no need to stay overnight in the hospital. Three day’s later after the surgery, the dressing will be changed in the clinic. For knee, hip or ankle arthroscopy, you may need to use crutches if you are not able to weight bear.

Why Arthroscopy Is Done?

Arthroscopy for rheumatoid arthritis is done to treat large joints such as hip, shoulder and knee. The procedure of an arthroscopy include:

  • Cleaning and removing debris from the joint.
  • Removing loose bodies (pieces of bones or cartilage floating) from the joint.
  • Shave out rough or irregular joint surfaces.
  • Removal of inflamed tissues  in the joints.

Arthroscopy is not suitable for severe damage to the joint.

How Well Does Arthroscopy Works?

Arthroscopy provides pain relief to a certain extent and sometimes it can help to improve the range of movement.

Risks of Arthroscopy

As with all other surgery, there is a risk in arthroscopy. However, the risk is small such as infection or bleeding in the joint.

What To Think About Should You Decide for Arthroscopy

Arthroscopy helps for many conditions as it provides a window for the surgeon to view the actual condition of the joint and the surgeon can perform repair at the same time. Bear in mind, arthroscopy for rheumatoid arthritis can help with the symptoms but it does not cure the underlying rheumatoid arthritis disease.

Call (+65) 6471 2674 (24hr) to fix an appointment to see our orthopaedic surgeon to discuss arthroscopy for rheumatoid arthritis in detail today.