Herniated Disc

Wear and tear, also called disc degeneration, is the usual cause of a herniated disc. As we age, the discs in our spine lose some of the fluid that helps them stay flexible. The outer layer of the discs can form tiny tears or cracks.  The jellylike material (nucleus) inside the disc may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, rupture or break into fragments.

A herniated disc can also happen when you injure your back. Injury can occur from:

• A sudden, heavy strain or increased pressure to the lower back. Sometimes a sudden twisting movement or even a sneeze will force some of the material out.
• Activities that are done repeatedly may stress the lower back. Examples include poor lifting habits, being exposed to vibration for a long time and sports-related injuries.

Herniated discs in any location along the spine can cause pain, numbness or weakness. Depending on the affected discs, you may experience symptoms in the neck, shoulders, chest, arms, hands or legs. In rare cases, a very large herniated disc in the neck may cause weakness or unusual tingling affecting other parts of the body, including the legs.

Keep in mind that if a herniated disc isn't pressing on a nerve, you may have no symptoms at all.

A doctor usually can diagnose a herniated disc from your history of symptoms and a physical exam. Your doctor will ask about pain and numbness that might be caused by irritation of one or more of the nerves in the spine. Your doctor may prescribe rest and rehabilitation (rehab) before further testing is done. If other conditions are suspected, or if there is no improvement in symptoms after a period of rest and rehab, imaging tests such as X-ray, magnetic resonance imaging (MRI), or computerized tomography (CT scan) may be done.

Usually a herniated disc heals on its own. If treatment is needed, a non-surgical approach is typically used first including:

• Home care, such as resting if you have severe pain, taking short walks and using heat or ice for pain.
• Doing exercises that your doctor or physical therapist prescribes. These may include core exercises, which can help you strengthen the muscles of your trunk to protect your back.
• Taking medicines to treat your symptoms, such as NSAIDs (ibuprofen, naproxen). If NSAIDS are not effective, then stronger pain medicines, muscle relaxers, and/or antidepressants may be used. Corticosteroid shots in the back are also sometimes used.
• Not smoking will be beneficial. Nicotine can harm the discs in your back because it negatively impacts how well the discs can absorb the nutrients they need to stay healthy. In addition, nicotine may cause them to become dry and brittle.
• Complementary medicine is sometimes used in conjunction with standard or conventional care to treat pain caused by certain herniated discs. Complementary therapies may include acupuncture, manipulation of the spine, massage, or chiropractor.

Symptoms usually improve over time. If the herniated disc is squeezing your spinal cord or nerves and/or you are having on-going weakness, constant pain or decreased control of your bladder or bowels, surgery will be considered.

Common surgical treatment

Surgery can be a good choice for those who have nerve damage that is getting worse or disabling pain after several weeks of non-surgical treatment.

Lumbar discectomy
The most common surgery for herniated disc is lumbar discectomy. In this procedure, the herniated disc material that is pressing on a nerve root or on the spinal cord is removed. Both a traditional approach and a minimally invasive approach to a discectomy are offered by Parkview Neurosciences. As a new patient, you will be evaluated on an individual basis to determine the best approach for you. If the minimally invasive discectomy approach is taken, a small incision is made in the skin and only the bone that is pinching the nerve is removed.

Following surgery, your doctor may recommend physical therapy and home exercises to help you recover. Recovery time is typically brief after discectomy and individuals may return to work and daily activities soon after surgery.

Lumbar laminotomy or laminectomy
This procedure is sometimes performed prior to a discectomy to allow the surgeon to better see the herniated disc. A small piece of bone (the lamina) is removed from the affected vertebra before the disc material is removed. In addition, this process reduces pressure on the spinal cord or spinal cord nerve roots.

These procedures are performed in a hospital operating room or in an outpatient surgery center. As with any surgery, there are some risks for surgical treatment of a herniated disc. Talk with your physician to help determine if surgery is the best option for you.

Call 911 anytime you think you may need emergency care. For example, call if you are unable to move a leg.

Call your doctor now or seek immediate medical care if you have new or worse symptoms in your arms, legs, chest, belly or buttocks.

If the condition is progressing, symptoms may include:

• Numbness or tingling
• Weakness
• Pain
• Loss of bladder or bowel control

Watch closely for changes in your health and be sure to contact your doctor if you are not getting better as expected.