Lumbar Lateral Disc Prolapse

Lumbar lateral disc prolapse—often called a lateral herniated disc—occurs when the soft, jelly-like center (nucleus pulposus) of an intervertebral disc pushes out through a tear in its tougher outer ring (annulus fibrosus) toward the side of the spinal canal. When this lateral herniation presses on nearby nerve roots, it can cause localized lower-back pain, radiating leg pain (sciatica), numbness, or weakness Mayo ClinicSpine-health.

Anatomy of the Lumbar Lateral Disc Prolapse

Structure & Location

The intervertebral disc is a fibrocartilaginous cushion sandwiched between adjacent lumbar vertebral bodies (from L1–L2 down to L5–S1). Each disc comprises two main parts: a tough outer ring called the annulus fibrosus and a gelatinous core called the nucleus pulposus. In a lateral disc prolapse, the disc material herniates toward the side of the spinal canal—specifically into the lateral recess, the narrow channel just medial to the neuroforamen through which nerve roots exit. This lateral location can compress exiting nerve roots or the thecal sac, causing characteristic radicular symptoms on one side.

A detailed understanding of where the disc sits is crucial: the disc lies posterior to the vertebral bodies, anterior to the spinal canal, and, in lateral prolapse, protrudes into the side walls of the canal. Because the lateral recess is narrower than the central canal, even small herniations here can produce significant nerve compression.

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Origin & Insertion

While intervertebral discs do not “originate” or “insert” in the way muscles do, the annulus fibrosus fibers anchor firmly into the endplates of the adjacent vertebral bodies. These endplates are thin layers of hyaline cartilage covering the top and bottom of each vertebral body. Fibers from the outer annulus penetrate into the ring apophysis (the bony rim of the vertebral body), securing the disc in place. This firm anchorage resists shear forces yet allows slight movement between vertebrae, permitting flexion, extension, and rotation.

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Blood Supply

Unlike most tissues, the intervertebral disc is largely avascular by adulthood. During childhood, small capillaries penetrate the outer annulus, but these regress, leaving only the peripheral annular fibers with a sparse blood supply. Nutrition thereafter depends on diffusion from the capillary beds in the adjacent vertebral endplates. This limited vascularity impairs healing once a disc is damaged, making a prolapse more likely to persist or worsen over time.

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Nerve Supply

The outer third of the annulus fibrosus is innervated by the sinuvertebral nerve (also called the recurrent meningeal nerve), which branches from the ventral ramus of the spinal nerve and the grey ramus communicans. It encircles the posterior aspect of the vertebral body and disc, relaying pain signals when the annulus is stretched or torn. In lateral prolapse, this nerve—and often the exiting nerve root itself—can be directly irritated by herniated disc material, producing sharp, shooting pain that radiates down the corresponding dermatome.

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Functions of the Intervertebral Disc

1. Shock Absorption
   The gelatinous nucleus pulposus acts like a fluid cushion, absorbing and distributing compressive forces across the vertebral bodies during activities such as walking or jumping.

2. Load Distribution
   Discs evenly spread mechanical loads across the lumbar spine, protecting bone surfaces and maintaining spinal alignment under heavy loads, such as lifting.

3. Mobility & Flexibility
   By allowing slight separation and gliding between vertebrae, discs facilitate forward flexion, backward extension, lateral bending, and rotation of the trunk.

4. Torsional Resistance
   The concentric lamellae of the annulus fibrosus resist twisting forces, preventing excessive rotation that could damage spinal cord or nerve roots.

5. Vertical Height Maintenance
   Healthy discs maintain the normal spacing between vertebrae, preserving foraminal height and preventing nerve root compression.

6. Spinal Stability
   Through a balance of tension in the annulus and pressure in the nucleus, discs contribute to the overall biomechanical stability of the lumbar spine, working in concert with ligaments and muscles.

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Types of Lumbar Lateral Disc Prolapse

Disc herniations are classified both by morphology and by anatomical location within or adjacent to the spinal canal:

By Morphology

• Disc Bulge: A broad-based outpouching of the annulus fibrosus that affects more than 25% of the disc circumference without focal tear.

• Protrusion: A focal herniation in which the base is wider than the protruding “cap,” indicating early annular disruption.

• Extrusion: The nucleus pulposus breaks through the annulus fibrosus, forming a herniated fragment whose base is narrower than its body.

• Sequestration: A free fragment of disc material has completely separated from the parent disc and may migrate up or down the canal.

By Anatomical Location

• Lateral Recess Prolapse: Herniation into the narrow lateral recess just medial to the neural foramen.

• Foraminal Prolapse: Disc material extends into the neural foramen, compressing the exiting nerve root at its exit zone.

• Extraforaminal (Far Lateral) Prolapse: Herniation occurs lateral to the foramen, often compressing the dorsal root ganglion.

• Central vs. Paracentral: Although central herniations press on the thecal sac, paracentral herniations skew slightly lateral, often affecting traversing nerve roots.

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Causes of Lumbar Lateral Disc Prolapse

1. Age-Related Degeneration
   As we age, the nucleus pulposus loses water content, becoming less pliable. Fibers in the annulus fibrosus weaken and develop microtears, making the disc prone to herniation under normal loads.

2. Genetic Predisposition
   Variations in genes coding for collagen and proteoglycans affect disc integrity. Families with early disc degeneration history often see younger individuals with herniations.

3. Occupational Overload
   Jobs involving heavy lifting, vibration (e.g., truck drivers), or repetitive bending impose chronic stress on lumbar discs, accelerating wear and tear.

4. Poor Posture
   Slouching or sustained forward flexion increases intradiscal pressures, particularly in the posterior-lateral region, fostering lateral prolapse over time.

5. Obesity
   Excess body weight magnifies compressive forces on the lumbar discs, hastening degeneration and increasing the risk of a tear in the annulus fibrosus.

6. Smoking
   Nicotine impairs blood flow to vertebral endplates, reducing nutrient diffusion to the disc and promoting degeneration.

7. Traumatic Injury
   Sudden impacts—like a fall from height or a car accident—can cause acute annular tears and immediate disc herniation.

8. Repetitive Microtrauma
   Even low-grade stresses, when repeated thousands of times (e.g., in assembly-line work), gradually weaken the annulus.

9. Heavy Weightlifting
   Lifting beyond one’s capacity without proper technique spikes intradiscal pressure, potentially tearing fibers in the annulus.

10. Connective Tissue Disorders
    Conditions like Ehlers–Danlos syndrome produce lax connective tissue, including an inherently weaker annulus fibrosus.

11. Spinal Deformities
    Scoliosis or hyperlordosis alters load distribution across discs, making lateral regions more vulnerable to herniation.

12. History of Back Surgery
    Surgical removal of posterior elements can change biomechanics, shifting stress onto adjacent discs.

13. Inflammatory Arthritis
    Diseases such as ankylosing spondylitis can weaken endplates and discs via chronic inflammation.

14. Prolonged Vibration Exposure
    Frequent exposure to vibrations (e.g., power tools) transmits oscillatory stress into discs, leading to microtears.

15. Rapid Weight Gain
    Sudden increases in body mass, such as during pregnancy, dramatically raise intradiscal loads in a short time span.

16. Poor Core Strength
    Weak abdominal and paraspinal muscles offer inadequate spinal support, transferring greater loads to discs.

17. High-Impact Sports
    Activities like gymnastics or wrestling subject the spine to repetitive hyperflexion and extension, risking annular injury.

18. Cumulative Inspiratory Strain
    Conditions causing chronic coughing (COPD, asthma) repeatedly jerk the spine, increasing risk of annular tears.

19. Disc Dehydration
    Loss of proteoglycans in the nucleus pulposus reduces disc height and resilience, predisposing the disc to prolapse.

20. Metabolic Disorders
    Diabetes mellitus can alter collagen cross-linking in the annulus, making fibers more brittle and prone to tearing.

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Symptoms of Lumbar Lateral Disc Prolapse

1. Unilateral Lower Back Pain
   A constant or intermittent ache on one side of the lower back, aggravated by movement.

2. Radicular Leg Pain
   Sharp, shooting pain radiating down the thigh or calf along the distribution of the compressed nerve root.

3. Paresthesia
   Tingling or “pins and needles” sensations in the leg or foot corresponding to the affected dermatome.

4. Muscle Weakness
   Weakness in specific muscle groups (e.g., quadriceps with L3–L4 involvement or dorsiflexors with L4–L5).

5. Diminished Reflexes
   Reduced or absent knee-jerk (L4) or ankle-jerk (S1) reflex on the side of the herniation.

6. Gait Disturbance
   An antalgic (pain-limiting) gait or foot drop may occur if nerve compression impairs dorsiflexion.

7. Neurogenic Claudication
   Leg cramping or heaviness after walking short distances, relieved by flexing forward or sitting.

8. Pain on Coughing/Sneezing
   Increases intradiscal pressure, transiently worsening nerve root compression and pain.

9. Radicular Numbness
   Loss of light touch or pinprick sensation in the dermatomal distribution of the affected nerve.

10. Electrical Shock–Like Sensations
    Brief, intense jabs of pain down the leg when performing certain movements.

11. Muscle Atrophy
    Chronic denervation can lead to wasting of calf or thigh muscles over weeks to months.

12. Positive Straight Leg Raise
    Radiating pain when the straight leg is raised between 30° and 70°, indicating nerve root tension.

13. Pain Aggravated by Extension
    Standing or leaning back narrows the lateral recess further, increasing symptoms.

14. Relief with Flexion
    Bending forward or sitting often eases pressure on the nerve, reducing pain.

15. Leg Cramping
    Involuntary muscle spasms in the calf or foot, often at night.

16. Altered Gait Mechanics
    Shuffling or limp to minimize nerve stretching.

17. Bladder or Bowel Dysfunction (rare but serious)
    Sudden onset of incontinence may signal cauda equina involvement and warrants emergency evaluation.

18. Sexual Dysfunction
    Nerve involvement may impair sensation or function, especially with S2–S4 compression.

19. Diffuse Lower Limb Heaviness
    A feeling of leg fatigue or “heaviness” after minimal activity.

20. Activity-Related Exacerbation
    Pain spikes during lifting, twisting, or prolonged standing.

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Diagnostic Tests for Lumbar Lateral Disc Prolapse

Physical Examination Tests

1. Inspection
   Observe posture, limb alignment, gait pattern, muscle bulk, and any antalgic stance.

2. Palpation
   Gentle pressure over paraspinal muscles and spinous processes can localize tenderness or muscle spasm.

3. Range of Motion (ROM)
   Assess lumbar flexion, extension, and lateral bending; limited motion often correlates with pain.

4. Straight Leg Raise (SLR) Test
   Passive elevation of a supine patient’s leg stretches the lumbosacral nerve roots; pain between 30°–70° suggests disc herniation.

5. Crossed SLR Test
   Raising the unaffected leg produces pain in the symptomatic leg; high specificity for large herniations.

6. Gait Assessment
   Watch for foot drop, limping, or antalgic gait patterns that indicate nerve root compromise.

Manual (Provocative) Tests

1. Slump Test
   Seated patient slumps forward with neck flexed, knee extended, then dorsiflex foot; reproduction of symptoms points to nerve tension.

2. Kemp’s Test
   With patient standing, extend and rotate the lumbar spine toward the symptomatic side; exacerbation of pain suggests facet or lateral recess involvement.

3. Femoral Nerve Stretch Test
   Prone patient’s knee is flexed; anterior thigh pain indicates L2–L4 root irritation.

4. Bowstring (Popliteal) Test
   In supine SLR, when pain arises, flex the knee slightly to relieve it, then apply pressure in the popliteal fossa; pain return confirms tension on the sciatic nerve.

5. Passive Lumbar Extension Test
   With patient prone, lift both legs a few inches off the table; lumbar pain and neurological signs suggest instability or central stenosis.

6. Bechterew’s Test
   Patient seated performs a straight leg raise on each side and then both together; radicular pain on either indicates nerve tension.

Laboratory & Pathological Tests

1. Complete Blood Count (CBC)
   Rules out infection (elevated white cell count) or anemia that could mimic mechanical pain.

2. Erythrocyte Sedimentation Rate (ESR)
   Elevated in inflammatory or infectious conditions affecting the spine.

3. C-Reactive Protein (CRP)
   More sensitive than ESR for acute inflammation or infection.

4. Discography
   Injection of contrast into the disc under fluoroscopy can reproduce pain and outline annular tears, helping pinpoint symptomatic levels.

5. Histopathological Analysis
   Rarely used except in surgical specimens to rule out neoplasm or infection.

6. Microbiological Culture
   If disc infection (discitis) is suspected, aspirate or biopsy samples can identify bacterial or fungal pathogens.

Electrodiagnostic Tests

1. Electromyography (EMG)
   Detects denervation or reinnervation patterns in muscles supplied by compressed nerve roots.

2. Nerve Conduction Studies (NCS)
   Measures the speed and amplitude of electrical impulses along peripheral nerves; slowed conduction suggests nerve compression.

3. Somatosensory Evoked Potentials (SSEPs)
   Records cortical responses to peripheral stimuli; abnormalities suggest dorsal column or nerve root involvement.

4. Motor Evoked Potentials (MEPs)
   Evaluates motor pathways by stimulating the cortex and recording muscle responses; can detect proximal conduction blocks.

5. F-Wave Studies
   Late responses from antidromic stimulation of motor nerves; useful for detecting proximal lesions.

6. H-Reflex
   Analogous to the ankle reflex measured electrically; prolonged latency may indicate S1 root compression.

Imaging Tests

1. Plain Radiography (X-Ray)
   Initial screen to assess alignment, disc height loss, osteophytes, or spondylolisthesis.

2. Magnetic Resonance Imaging (MRI)
   Gold standard for visualizing disc herniation size, location, nerve root impingement, and associated edema.

3. Computed Tomography (CT)
   Excellent bony detail; combined with myelography (CT myelogram) it can reveal nerve compression when MRI is contraindicated.

4. CT Myelogram
   Injection of contrast into the thecal sac followed by CT images provides dynamic views of nerve root compromise.

5. Discography Imaging
   Fluoroscopic images during discography help map annular fissures and reproduce patient pain.

6. Bone Scan (Technetium-99m)
   Highlights areas of increased bone turnover; useful in suspected infections, tumors, or stress fractures that mimic discogenic pain.

Non-Pharmacological Treatments

Below are 30 conservative therapies, each with a brief description, purpose, and mechanism.

1. Physical Therapy (PT)

   • Description: Guided exercises and manual techniques.

   • Purpose: Improve strength, flexibility, and posture.

   • Mechanism: Targets core stabilization and lumbar extension movements to reduce nerve compression Spine-health.

2. Massage Therapy

   • Description: Hands-on muscle manipulation.

   • Purpose: Relieve muscle tension and spasms.

   • Mechanism: Increases blood flow, delivering oxygen and nutrients to injured tissues Spine-health.

3. Spinal Manipulation

   • Description: High- or low-velocity thrusts performed by a chiropractor or osteopath.

   • Purpose: Restore joint mobility and alleviate pain.

   • Mechanism: Adjusts spinal alignment, reducing pressure on nerves Spine-health.

4. Heat Therapy

   • Description: Application of warm packs or heating pads.

   • Purpose: Relax muscles and improve circulation.

   • Mechanism: Vasodilation increases oxygen delivery, aiding healing.

5. Cold Therapy

   • Description: Ice packs or cold wraps.

   • Purpose: Reduce inflammation and numb pain.

   • Mechanism: Vasoconstriction limits swelling around the nerve.

6. Transcutaneous Electrical Nerve Stimulation (TENS)

   • Description: Electrical impulses delivered via skin electrodes.

   • Purpose: Block pain signals.

   • Mechanism: Stimulates large nerve fibers to inhibit pain pathways.

7. Ultrasound Therapy

   • Description: Sound‐wave treatment.

   • Purpose: Promote tissue healing and reduce inflammation.

   • Mechanism: Deep heat from ultrasound waves increases cell metabolism.

8. Traction

   • Description: Mechanical stretching of the spine.

   • Purpose: Decompress discs and nerve roots.

   • Mechanism: Creates negative pressure inside the disc, retracting herniated material.

9. Yoga and Pilates

   • Description: Structured stretching and strengthening programs.

   • Purpose: Enhance flexibility and core support.

   • Mechanism: Improves spinal alignment and supports disc health.

10. Aquatic Therapy

    • Description: Exercise in a pool.

    • Purpose: Low-impact strength training.

    • Mechanism: Buoyancy reduces spinal load while water resistance builds muscle.

Drugs

(Dosages and side effects adapted from MedlinePlus and Pain Relievers overview.)

Dietary Molecular Supplements

1. Glucosamine Sulfate (1,500 mg/day)

   • Function: Supports extracellular matrix synthesis.

   • Mechanism: Provides building blocks for proteoglycan formation in disc cartilage PMCPMC.

2. Chondroitin Sulfate (1,200 mg/day)

   • Function: Maintains disc hydration.

   • Mechanism: Inhibits proteoglycan breakdown, improving water retention.

3. Collagen Peptides (10 g/day)

   • Function: Enhances disc tensile strength.

   • Mechanism: Supplies amino acids for collagen repair.

4. Methylsulfonylmethane (MSM) (2,000 mg/day)

   • Function: Reduces inflammation.

   • Mechanism: Donates sulfur for antioxidant enzyme synthesis PMC.

5. Vitamin C (500 mg/day)

   • Function: Collagen synthesis cofactor.

   • Mechanism: Essential cofactor for pro-collagen hydroxylation.

6. Vitamin D3 (1,000 IU/day)

   • Function: Bone and disc health.

   • Mechanism: Regulates calcium metabolism, supporting endplate integrity.

7. Vitamin B12 (1,000 mcg/week)

   • Function: Nerve health.

   • Mechanism: Supports myelin sheath maintenance.

8. Curcumin (500 mg/day)

   • Function: Anti-inflammatory.

   • Mechanism: Inhibits NF-κB signaling, reducing cytokine production.

9. Omega-3 Fatty Acids (1 g/day EPA/DHA)

   • Function: Resolves inflammation.

   • Mechanism: Produces anti-inflammatory eicosanoids.

10. Hyaluronic Acid (200 mg/day)

    • Function: Improves disc lubrication.

    • Mechanism: Enhances water retention in extracellular matrix.

Advanced Drugs

1. Alendronate (70 mg/week) – Bisphosphonate

   • Function: Reduces bone turnover.

   • Mechanism: Inhibits osteoclasts, stabilizing endplate and disc.

2. Zoledronic Acid (5 mg IV annually) – Bisphosphonate

   • Function: Similar to alendronate with yearly dosing.

3. Platelet-Rich Plasma (PRP) (3 mL injection) – Regenerative

   • Function: Enhances healing.

   • Mechanism: Delivers growth factors to the disc.

4. Autologous Conditioned Serum (2 mL injection) – Regenerative

   • Function: Reduces inflammation.

   • Mechanism: Contains IL-1 receptor antagonist.

5. Hyaluronic Acid Injection (2 mL of 20 mg/mL) – Viscosupplement

   • Function: Improves disc hydration.

   • Mechanism: Restores viscoelastic properties.

6. Sodium Hyaluronate (2 mL injection) – Viscosupplement

   • Function: Similar to HA.

7. Autologous Mesenchymal Stem Cells (MSCs) (1×10⁶ cells) – Stem Cell

   • Function: Disc regeneration.

   • Mechanism: Differentiate into nucleus pulposus–like cells.

8. Allogeneic Umbilical Cord MSCs (1×10⁶ cells) – Stem Cell

   • Function: Same as above.

9. iPSC-Derived MSCs (1×10⁶ cells) – Stem Cell

   • Function: Same as above.

10. Bone Marrow Concentrate (5 mL injection) – Stem Cell

    • Function: Contains MSCs and growth factors.

(Early clinical data suggest safety and potential efficacy, but large RCTs are pending.) PMCPMC

Surgeries

1. Microdiscectomy

   • Procedure: Small midline incision; remove herniated fragment under microscope.

   • Benefits: Quick nerve decompression; rapid pain relief Spine-healthSpine-health.

2. Endoscopic (Percutaneous) Discectomy

   • Procedure: Tiny portal and endoscope remove disc material.

   • Benefits: Minimally invasive; outpatient recovery.

3. Open Laminectomy

   • Procedure: Remove part of vertebral lamina to relieve nerve pressure.

   • Benefits: Broad decompression for severe stenosis.

4. Foraminotomy

   • Procedure: Widen neural foramen.

   • Benefits: Relieves nerve root impingement.

5. Posterior Lumbar Interbody Fusion (PLIF)

   • Procedure: Disc removal with bone graft between vertebrae.

   • Benefits: Stabilizes spine; prevents recurrent herniation.

6. Transforaminal Lumbar Interbody Fusion (TLIF)

   • Procedure: Lateral approach for fusion and graft placement.

   • Benefits: Less muscle disruption.

7. Anterior Lumbar Interbody Fusion (ALIF)

   • Procedure: Anterior abdominal approach; disc removal and graft.

   • Benefits: Preserves posterior muscles; larger graft surface.

8. Extreme Lateral Interbody Fusion (XLIF)

   • Procedure: Lateral retroperitoneal approach.

   • Benefits: Minimal muscle cutting; indirect decompression.

9. Artificial Disc Replacement

   • Procedure: Replace disc with prosthetic device.

   • Benefits: Maintains motion; avoids fusion.

10. Spinal Fusion with Instrumentation

    • Procedure: Metal screws/rods stabilize segment.

    • Benefits: Maximal stability in complex cases.

Prevention Strategies

1. Lift with legs, not back.

2. Maintain healthy weight.

3. Strengthen core muscles.

4. Practice good posture.

5. Use ergonomic chairs and workstations.

6. Take regular movement breaks.

7. Avoid smoking (reduces disc nutrition).

8. Stay hydrated.

9. Follow a balanced diet rich in calcium and vitamin D.

10. Wear supportive footwear.

(Preventive measures reduce spinal load and promote disc health.) Health

When to See a Doctor

• Severe pain unrelieved by rest or home care.

• Progressive neurological deficits (e.g., increasing leg weakness).

• Foot drop or inability to lift the foot.

• Loss of bowel/bladder control (cauda equina syndrome – emergency).

• Fever or signs of infection (if discitis is suspected).

• History of cancer or unexplained weight loss with back pain. Spine-health

Frequently Asked Questions

1. What exactly is a lateral disc prolapse?
   It’s when the disc’s nucleus pushes out through its outer ring toward the side, often pressing on exiting nerve roots.

2. How is it diagnosed?
   Through medical history, physical exam, and imaging (MRI is gold standard). Spine-health

3. What causes it?
   Age-related degeneration, heavy lifting, twisting injuries, genetics, smoking.

4. What symptoms should I expect?
   Lower-back pain, sciatica (leg pain), numbness, tingling, muscle weakness.

5. Can it heal on its own?
   Yes—80–90% improve with conservative care over 6–12 weeks. Verywell Health

6. Are injections effective?
   Epidural steroid injections can provide temporary relief by reducing inflammation.

7. When is surgery necessary?
   If severe pain persists beyond 6–12 weeks, or if there are red-flag neurologic signs.

8. What’s recovery like after microdiscectomy?
   Most patients return to normal activities in 2–4 weeks, with immediate leg-pain relief. Verywell Health

9. Will I need fusion after discectomy?
   Fusion is reserved for instability or recurrent herniations; most discectomies don’t require it.

10. Can lifestyle changes prevent recurrence?
    Yes—proper lifting, core exercises, and weight management reduce risk.

11. Do supplements help?
    Some evidence suggests glucosamine and chondroitin may aid early disc regeneration, but more trials are needed. PMC

12. What are the risks of long-term NSAID use?
    GI bleeding, kidney damage, increased cardiovascular risk.

13. Is stem cell therapy proven?
    Early-phase studies show safety; definitive efficacy data from large RCTs are pending.

14. How can I manage pain at home?
    Ice/heat, gentle stretching, OTC NSAIDs, and activity modification usually help.

15. When should I seek emergency care?
    Sudden leg weakness, loss of bowel/bladder control, or fever with back pain requires immediate attention.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 12, 2025.