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MESSAGES TO

Spine Health & Slipped Disc Treatment

A DxD Session with Dr Fong Shee Yan


Ended on Sat Feb 09 2019
Ended
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Top Answers


Without knowing the details of your uncle's surgeon nor surgery, in general, recovery after disc surgery depends on:

1. neck or back surgery (longer for neck)

2. fusion or non-fusion surgery (longer if fusion implants are used)

3. more than one disc or just single level (longer if multi-level surgery)

4. standard open surgery or minimally invasive approach (longer if larger incision wound e.g. minimal invasive single level lumbar disc surgery can be discharged the next day)

5. possible complications ocurring during or after surgery (longer if any) - this in turn depends on 

a) your uncle's health/fitness for undergoing major surgery anaesthesia 

b) your uncle's surgeon's years of experience/specialised training in spine surgery and whether he does minimally invasive surgery (if applicable) and whether the initial diagnosis for the surgery (e.g. slipped disc compressing his nerve) is completely eradicated by the surgeon without leaving any residual compression and with minimal collateral damage during the surgery

c) your uncle's recovery process during the first one month after his surgery in looking after his wound, his neck/back and his compliance in postoperative medications and rehab physio

Hence the common but important advice of going through all the abovementioned list of questions with his own surgeon individually and fully before consenting for surgery (assuming its not an emergency operation)

9 Jan 2019

It is very common to be told we have a "slipped" disc whenever an MRI scan is done for our back or neck pain.

However its a "misnomer" layman's term as only a minority (less than 10%) of discs actually ruptured or "slipped out".

This can cause dire consequences of compressing the adjacent spinal nerves or spinal cord, which usually necessitates open spinal surgery (not injections or disc-plasty "laser") to remove the offending EXTRUSION disc fragment.

This helps to decompress and "free" the nerve or cord (like removing a "burst" car tyre in a car workshop).

However, the majority of "slipped" discs in us (>90%) are actually degenerated disc PROTRUSION (like an old bulging worn-out car tyre).

This is because as we age, our cushioning spinal discs wear out naturally - see pictures below:

These natural aging processes do not reverse, heal or "cure" back to "normal" (like my white hair and creaking knees).

As such, the disc protrusions will remain forever in your MRI images even after the pain has recovered.

So unless the disc has unfortunately ruptured causing nerve pain in the arms/legs, all treatment is for the back/neck pain from wear/tear/overuse/injury of these already pre-existing but "painless" degenerated disc protrusions now suffering from inflammation resulting in pain.

In short, pain from an inflammed/injured discs must be treated not only to prevent worsening of your dad's pain, but more importantly to reduce the build up of the disc inflammation "pressure" leading ultimately to disc rupture, necessitating surgery.

Hence majority of this "discogenic" pain will slowly gradually recover with:

  • anti-inflammatory medications (including steroid nerve injections) together with
  • regular physical therapy (physio, tcm, chiro, osteo, etc) to reduce the intradiscal pressure ("stretching out the tight disc") and
  • strengthening the protective spinal core muscles (e.g. swimming, planking, yoga, pilates, etc)

However no more pain does not mean "cure", as recovered patients subjecting their discs again to repeated wear/tear/overuse/injury will very soon find out.

Another repeat MRI will confirm their degenerated disc STILL permanently there (hopefully the disc protrusion not becoming bigger) and if they don't wise up and practise good back/neck care and hygiene, they will eventually encounter worsening recurring relapsing back/neck pain attacks finally ending up with surgery.

Hence the common but important advice "prevention is better than cure".

10 Jan 2019

Surgery is not commonly needed for all natural aging disc protrusions (like a bulging old worn out car tyre) - only 10% require surgery ultimately either due to intractable or worsening pain/disability.

The majority 90% can be managed conservatively successfully and repeatedly with medications, physical therapy (physio, chiro, osteo, tcm), injections (including steroid, radiofrequency or "laser" disc-plasty) as long as the conditions do not worsen rapidly as they are being slowly and gradually managed.

The commonest reason for things going downhill unfortunately is an unforeseen acute or gradual accelerated weakening of the already pre-existing degenerated disc (from injury, sports, occupation, sedentary postures, etc).

It ruptures like a burst car tyre, with the extruded disc fragment compressing the adjacent spinal cord or nerve within the spine resulting in pain/weakness/numbness in arms/legs.

Rarely do patients experience end-stage paralysis and loss of arms/legs/bladder/bowel control (cauda equina syndrome) as this usually occur gradually with plenty of warning symptoms, signs and not to mention pain (as long as you don't get into a major trauma or fall from height) enough time for you to do an MRI scan to see the ruptured disc with the offending extruded disc fragment compressing nerve or spinal cord.

Traditional medical advice its dangerous to leave a "slipped" disc occupying/compressing >50% of the cord/nerve channel space in the MRI (some surgeons even suggest 30% or even less for surgery).

Only open surgery (NOT the abovementioned injections) is able to physically, completely and directly remove the offending disc. The aim is not simply to treat the pain for short term (>90% success rate) but more importantly to permanently remove the threatening disc for long term before it has a chance to gradually worsen further to irreversible loss of arms/legs/bladder/bowel control in the future (like a "time bomb" as quoted from one of my patient).

Just to be certain, I make sure to show the size of the disc fragment I removed to my patient after surgery and if insurance permits, to repeat another MRI after surgery to reassure my patient that the offending slipped disc in the preop MRI is no longer there and the spinal cord/nerves are now free (not unlike surgery for tumour - you don't want to leave anything behind!) without worrying about radiation unlike X-ray/CT scans.

Contrary to popular belief, a ruptured disc does not heal or regenerate (growing the disc back means getting the same disc slipped again!). And we can all live without a disc or two - in fact all our MRIs after age of 70-80 years old will show little discs left (all "collapsed") as all of our discs would have worn out naturally by then since the beginning of homosapiens walking on 2 legs instead of 4  (thats why we are given 5 lumbar discs and 6 cervical discs as "spare tyres") In the long run, our painful discs will either resolve naturally through slow gradual aging, or artificially through surgery if timely treatment is necessary.

11 Jan 2019

Microdiscectomy is the standard surgical procedure commonly performed when a disc needs to be removed usually because it is endangering a nearby spinal cord or nerve (e.g. if patient has worsening sciatica pain in his leg unable to walk).

It combines both the advantages of physical removal of the herniated disc out of the spine (unlike radiofrequency discoplasty "injection") with minimally invasive approach reducing risk of collateral damage, pain, bleeding and infection because of a smaller incision wound, enabling patient rapid recovery (early return to home and work) after microdiscectomy.

With these benefits follow the disadvantage of not able to remove 100% of the disc (at least 10% may remain - ironically also helping to preserve some motion), unlike a larger fusion surgery which necessitates complete 100% disc (and motion) removal before implant insertion.

Hence 10% risk of a recurrent/relapse re-prolapse of the remnant disc anytime in the future is always made known to all patients during their consent process before their first microdiscectomy surgery.

A relapse of his old preoperative sciatica confirmed by a repeat mri of a recurrent same disc herniation will warn of this complication.

Similar to his first episode, a repeat discectomy or even fusion surgery is necessary if this second episode cannot be controlled by conservative treatment. The most important prevention is to make sure the wound and back/neck recover as much as possible after the first surgery and rehab postop spinal physio done for core strengthening after the first surgery.

An important recent development is the use of a newer endoscopic discectomy surgery as an alternative to microdiscectomy (can even be done by a pain specialist who is not even a surgeon!).

Because of a now even smaller endoscopic access, more and more cases of recurrent disc herniation necessitating a repeat surgery have been reported in USA so patients/doctors please beware !

5 Feb 2019

According to Ministry of Health guidelines, laser treatment is currently NOT a recommended treatment for spinal disorders in Singapore (unlike in USA). In fact, laser spine surgery is NOT even included in the Ministry of Health list of Table for Surgical Procedures for purposes of fee benchmark/insurance/medisave claims !

Please be aware of this and double check with your specialist again if you are recommended to undergo laser spine treatment as you may be charged under another different spine procedure instead (e.g. radiofrequency discoplasty "injection" which is NOT laser treatment !)

Furthermore make sure your specialist is accreditated by hospital to allow him to use laser equipment (similar to eye surgeon using lasik) not all doctors are accreditated and use of laser has risks !

14 Feb 2019

Depending on the severity/size (or Stage) of your disc herniation in both your clinical signs and in your MRI, Stage 3 (large, severe) slipped disc must undergo surgery to improve no other choice !

Early Stage 1 (small, mild) and Mid Stage 2 (moderate disc bulge) can be "managed" by physical therapy whenever it "acts up" but without surgery cannot be permanently "cured".

As long as it doesn't escalate to Stage 3 or affect your quality of life/work, we can live with it with on-off treatment for relapses as long as physical therapy still helps, is non-invasive and can be repeated multiple times (unlike surgery).

In principle, low or non-impact "horizontal" exercises (swimming, yoga, etc) are safer for your lower back. You don't want high impact "vertical" exercises (running, racket games, etc) to stress your worn out L4-5 disc further !

14 Feb 2019

In principle, low or non-impact "horizontal" exercises (swimming, yoga, etc) are safer for your lower back. You don't want high impact "vertical" exercises (running, racket games, etc) to stress your worn out L4-5 disc further ! Heavy weight lifting stresses your back too if done upright "vertically" better to do them lying down "horizontally" or without bending your back.

14 Feb 2019

Top Questions


I have a herniated disc in my lumbar area for about 3 years now. I often experience pain shooting down my thighs and calves. What can I do to reduce the pain?

I am 48 this year. I’ve recently gotten an MRI and discovered that there’s mild disc bulge due to age and wear and tear. Is it safe for me to continue my sport-intensive lifestyle?

Hi, I'm a 26 year old male. I suffered a bulging lower back disc after my NS because of prolonged periods of carrying heavy equipment. Are there any ways of treating my bulging disc and back pain so that I'm able to carry heavy things again? 

I was working out at the gym recently and felt a snap on my back while doing weights. How do I find out if it’s a muscle strain or a herniated disc?
I have two herniated disc in my lumbar area. Will that make me shorter? If yes by how much, and how do I prevent it from making me shorter?

I was given an injection 2 months ago between the butt and hip to control my back pain due to degeneration of disk. However, I still feel some pain that comes and go. Is that normal? How long do steroid injections take to work, and how long is it effective for in reducing pain?

I am in my late 20s, and have scoliosis of about 30 degrees. How will scoliosis affect me as I grow older? What is the typical progression of scoliosis of my severity?

I am in my late 20s and have scoliosis. I have never received treatment, but I currently swim and do pilates regularly to improve my back pain. Will treatment become necessary eventually, and what will my treatment options be?