Herniated Disc treatment
What is a herniated disc?
When people say they have a “slipped” or “ruptured” disk in their neck or lower back, what they are actually describing is a herniated disk-a common source of pain in the neck, lower back, arms, or legs.
Anatomy of a disc
Disks are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the back to flex or bend. Disks also act as shock absorbers. Normal anatomy of lumbar spine.
Disks in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the disks are similar but smaller in size.
Cause of a herniated disc
A disk herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs. Herniations of discs are usually activity related and often preventable by the active pursuit of a healthy back.
Symptoms of a Herniated disc
Herniated disc in the Lower Back
Low back pain affects four out of five people. Pain alone is not enough to recognize a herniated disk as the symptoms mirror other spine conditions such as stenosis. See your doctor if back pain results from a fall or a blow to your back. The most common symptom of a herniated disk is sciatica—a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve.
Other symptoms include:
- Weakness in one leg
- Tingling (a “pins-and-needles” sensation) or numbness in one leg or buttock
- Loss of bladder or bowel control (If you also have significant weakness in both legs, you could have a serious problem and should seek immediate attention.)
- A burning pain centered in the neck
Herniated disc in the Neck
As with pain in the lower back, neck pain is also common. When pressure is placed on a nerve in the neck, it causes pain in the muscles between your neck and shoulder (trapezius muscles). The pain may shoot down the arm. The pain may also cause headaches in the back of the head. Other symptoms include:
- Weakness in one arm
- Tingling (a “pins-and-needles” sensation) or numbness in one arm
- Loss of bladder or bowel control (If you also have significant weakness in both arms or legs, you could have a serious problem and should seek immediate attention.)
- Burning pain in the shoulders, neck, or arm
Herniated Disc Treament
Conservative Herniated disc treatment
When you are showing signs of a herniated disc and you come to see a specialists the first step is going to be establishing if you are stable or not stable. If you are stable the physician will attempt to relieve your symptoms with conservative herniated disc treatments such as oral or localized steroids and recommend stretches, exercised, and decompression therapies. It is possible that they may want a MRI to confirm the diagnosis.
If oral and localized steroid injections fail, and after an MRI, you may be referred to a PM&R physician or a interventional pain management physician to receive a fluoroscope guided epidural steroid injection for relief. Epidural Steroid injections used for herniated disc treatment can offer significant relief. If relieve is achieved for a interval of time necessary for the area to heal, or where a cost benefit ratio is achieved where the patient is willing to continue treatments every two years or so, this can be the final repeated, as needed, step.
Surgical Herniated disc treatment
After conservative herniated disc treatment methodologies fail, or the patient is not stable and at risk of permanent damage to the nerves, than surgery can be considered; neurological deficits or muscle weakness are indicative of surgery without completion of conservative steps. Surgical herniated disc treatments can vary depending on the severity and location. It is a possibility that a patient may be eligible for minimally invasive surgery such as a microdiscetomy or more complex procedures that can involve replacement of discs and fusions of vertebral bodies.
Recovery from Herniated Disc Treatment
Recovery from a herniated disc treatment, minimally invasive or not, is not to be taken lightly. The spine is a vital area of the body and it is important to follow the surgeons directions explicitly and to call them at the first sign of any deviation from expectation; for example: redness, swelling, radiating heat, new pain, lack of bowl movements, dizziness, ect.
Many herniated disc treatments are outpatient procedures. You may leave the hospital the same day and have to wear a brace to restrict movement while healing. There will be follow up appointments and possible physical therapy. It is possible that symptoms may not be entirely relieved in cases that were not treated promptly of first symptoms; a compressed nerve takes damage over time with a 90 day average on people ending up with symptoms that do not resolve. It is important to see a specialist promptly when dealing with spine issues.
