What is Herniated Disc?
Discs are the cushion that acts as a shock absorber for the spine. Over time, and sometimes with injury or trauma, these discs can protrude and press on nerves of the spinal cord. It usually begins with a sharp pain but can be dull and chronic and worsens with activity. You may have numbness or tingling or even weakness of muscles as well. Other names for a herniated disc can include bulging disc, pinched nerve, slipped disc, ruptured disc, disc protrusion and torn disc. Although any spinal disc may herniate, they are most common in the lower back lumbar spine.
Pain is usually the first sign of a herniated disc. If the disc is in the lower back then you may have pain, weakness and numbness extending from your back to your buttocks, thighs, and down to your calves. If the disc is in your neck (cervical spine) then you may have the same symptoms in the neck and arms. You may have aching, tingling or burning sensations in the affected area. The pain is usually only on one side of the body but may be both. Movement, walking sitting and certain bending or twisting movements may worsen the pain. When you are unable to perform your normal daily activities then it is time to see your doctor.
A disc is made up a fibrous outer ring and a soft gelatinous inner portion. Injury or weakness from aging can cause the inner disc to protrude through the outer ring which can press on the sensory or motor nerves of the spinal cord causing symptoms.
Aging can cause outer ring to become thinned or weakened which allows the inner portion to slip out. Heavy lifting, repetitive motions or turning and twisting can also cause a herniated disc. Many times there is a sudden sharp pain in the spine area with resultant dull pain in the area of the nerve. Other factors that can predispose you to a herniated disk are having a few extra pounds, lack of exercise and weak muscles. Men are more likely to have herniated discs than women.
Your doctor will take a complete history which may when or how your injury occurred. A physical exam will evaluate you for your source of your pain and discomfort. Your nerve function will be evaluated along with and muscle strength and skin sensation. Imaging tests can help your doctor identify injured areas of spinal bones and muscles. X-rays may be used to look for fractures or tumors but will not show if you have a herniated disc.
Studies that may be used for diagnosis include a computed axial tomography (CAT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy spine and tissue around it. A myelogram uses dye injected into your spinal fluid and an X-ray to show the location of pressure on the spinal cord. A magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the spine, spinal cord and spinal nerves. Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted. An electromyogram uses needle electrodes to look for muscle damage.
A herniated disk will frequently improve with conservative treatment within a few weeks. Resting can allow your back to heal. Ice or heat in the are of discomfort may help you feel better. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. If pain of a herniated disc lasts more than 10 days you should talk to your doctor as the side-effects of long term NSAID use rarely include stomach ulcers, circulation problems and heart failure. Muscle relaxants and nerve pain medications can also be used. Stretching and exercises may help improve the symptoms of a herniated disc. A physical therapist can show you which exercises that can be safe and effective for you.
Surgery may be needed if you have a sudden severe herniated disc to prevent nerve damage or if conservative treatments do not relief pain. Surgery will also relieve pain much more rapidly than rest and medication. You may require one or a combination of the following procedures.
- Laminectomy or laminotomy– your surgeon uses a microscope to make a small opening in the spinal bone (vertebral arch) to relieve pressure on the nerve roots.
- Discectomy or microdiscectomy– the most common herniated disc surgery in the lumbar region involves removing all or a portion of the herniated disc that is pressing on your nerve root. A microdiscectomy uses smaller instruments which are less invasive and can be an outpatient procedure.
- Artificial disc surgery– is used when only a single disc in the lower back is involved and you do not have widespread arthritis or osteoporosis. An abdominal incision is used to approach the spine and an artificial disc replaces the herniated disc. This requires general anesthesia and generally a short hospital stay.
- Spinal fusion– two of more of the spinal vertebrae are permanently attached together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae in the attached segments. This also requires general anesthesia and a short hospital stay.
The pain of a herniated disc can be excruciating and debilitating. The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of herniated discs. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).