 I am Dr. Ishwar Kirti, the Head of Department of Spine Surgery at KMC Mangalore. We will talk about lumbar disc prolapse. So lumbar disc prolapse is one of the most common problem with which a patient comes to a spine OPD. These patients present with severe pain in the back and the pain going down the legs. See, not all back pains are because of lumbar disc prolapse, but most of them are because of lumbar disc prolapse. Pain will be in the lower part of the back that is called lumbar region. So this is lumbar region, this is thoracic and when you go up it is called the cervical region. So in the lower lumbar area, patient will present with severe back pain that is also called lumbago. The pain may be in the center of the back or it can be from the right or left side, either side of the back. And another symptom with these patients present is they will have the pain going from the back to the legs that is the back of the thigh and back of the leg and may be going down to the foot that is commonly called sciatica. So this back pain and sciatica are the most common symptoms with which patients present to our spine OPD. So with these complaints if somebody presents, we diagnose it as lumbar disc prolapse. And some of these patients will also have some kind of tingling and numbness in the feet or in the some lower part of the leg that is called pins and needles. That is because of the disc prolapse which is happening in the lumbar area, it is pressing on the spinal nerves. So they will get damaged and they will give the symptoms of pins and needles in the legs. There can also be some weakness in the lower limb and legs also. And in very rare cases, patients may present with a problem in passing urine or problem in controlling urine or even motion. That is called cauda equine syndrome and that needs urgent attention. So these are the symptoms of lumbar disc prolapse. So what we do next, when the patient comes and presents with all these symptoms, we next go for some investigation like MRI. So before that, I will tell you what is the lumbar disc. People should know what is a lumbar disc. This is the lumbar spine and these are called vertebrae. The spinal column is made up of individual vertebrae. So this is the bone and this is the bone down here. Disc is a part, it is like a cushion or a shock absorber between these two bones. This is called disc. So this disc is made up of jelly kind of material. There are two materials. One is the inside ring, outside ring and inner jelly. This yellow part is the inner jelly which is contained by an outside ring. So what happens in the lumbar disc prolapse is this inner jelly will leak out through a tear in the outer ring. There is a tear here, there is a tear here and there is a tear here and this inner jelly will leak out from this through this tear and the leaked out jelly that will no more be in jelly in consistency, it will become hard and that will press on the nerves. This yellow part is the nerves. So when that produces pressure on the nerves, you will get the sciatica symptoms that is the pain going down to the legs and these nerves may get damaged and we may lose power of legs or we may can become some kind of paralysis. So this is what happens in lumbar disc. When we do this MRI scan, we will exactly know which level there is a disc prolapse. So each levels are numbered like L4, L5, L3 like that. So which level is the disc prolapse? Whether the disc is coming on the right side or left side and how severely it is pressing on the nerves. So the most common treatment for lumbar disc prolapse is conservative therapy. We try to treat most of almost all patients without surgery. So the conservative therapy consists of mainly the painkillers and some kind of muscle relaxants, maybe a short course of physiotherapy and some medicines to relieve the pain of nerves. They are called neurotrophics. Most of the patients, maybe 60 to 70% of the patients will become better with this conservative therapy, maybe a short period of bed rest one or two days. But mind you, there is no need for long period of bed rest. The bed rest is only for one or two days, not more than two days. So after this patients can resume their routine work, we tell them to avoid this intense activities or straining activities like driving, going out for their work and all. But household and walking around they can do. Within a week, these symptoms will come down with medications and short course of physiotherapy and two days of rest. If some people, they are not becoming better with this conservative therapy or the people who have become better with conservative, they may get another episode of this back pain. So such people, we may have to go for some other kind of modality of treatment other than conservative therapy. So at the end of conservative therapy, what we advise is to do regular back exercises, prevention of another episode like this to go for any further management. Those who are not becoming better with this conservative therapy, we will advise them to go for another slightly more invasive therapy that is called spinal injections. There are variety of injections available. So we can go into the location where the exactly the problem is there and we can give steroid or any other medication injection to that area to relieve symptoms. At least 80 to 90 percent of the patients will become better with these kind of injections and conservative therapy and they will not need any surgical modality. But the most important thing is the duration after our treatment. The patient should do some regular care of back and do some regular exercises to prevent further episodes. Some patients that I said it is around 80 to 90 percent will become better. Patients who are present with severe neurological deficit that is some kind of paralysis or patients who are becoming bladder and bowel symptoms that is urine, difficulty in urine and all then we will go directly go for surgical treatment. So surgical treatment what we do at KMC is the most advanced kind of surgery what we do. What is called endoscopic dyskectomy that is kind of a minimally leased invasive keyhole operation for lumbar disc prolapse. This can be done even under local anesthesia. So in what we do in endoscopic dyskectomy is we put a small endoscope through a small hole from the back. We put a scope directly into the disc and remove only the part which is damaging the spinal nerves. So once we remove this part which is pressing the nerves and this nerves pressure on this nerve will relieve and the symptoms will come down. We will not damage any of these bones or any other structure or the rest of the discs. So again the disc surgery alone is not a complete treatment lifestyle changes and regular exercises strengthening the muscle is a key thing in treatment of lumbar disc prolapse.