The spine is made up of a column of bones separated by spongy intervertebral discs. These discs allow the spine to move and also act as shock absorbers preventing the bones of the spinal column from grinding against one another. Each disc is made up of a strong outer ring of fibers called the annulus fibrosus and a soft, gel-like center called the nucleus pulposus. The outer ring of thick fibers attaches to the vertebrae and holds the disc in place.
A herniated disc occurs when the outer fibers tear or rupture and the gel-like center moves out of its normal position and into the limited space of the spinal canal. The displaced disc may compresses nearby spinal nerves or exert pressure on the spinal cord. In addition, the gel-like center releases chemical irritants that can cause nerve inflammation and pain. Herniated discs can occur in any area of the spine; however, they are more likely to occur in the lower back.
When a herniated disc presses on a nerve, pain, numbness, and/or weakness of the affected area may result. In contrast, if a herniated disc is not pressing on a nerve, mild pain may be the only symptom. The location of the herniated disc and the severity of the herniation dictate symptoms.
Symptoms of herniated disc in the lower back include:
- Mild to severe lower back pain. Pain aggravated by movement.
- Muscle spasm
- Sciatica (pain, burning, tingling, or numbness that extends from the buttock into the leg or foot)
- Leg weakness or loss of leg function
Symptoms of a cervical (neck) herniated disc may include:
- Mild to sharp pain in the neck or between the shoulders blades. Pain aggravated by movement.
- Pain that radiates down into the arm, hand or fingers. This is called a radiculopathy.
- Numbness or tingling in the shoulder or arm.
Herniated discs are most common in young and middle-aged adults. Factors that can increase risk for disc herniation include:
- Excessive force to the spine i.e., falling or collision injuries
- Incorrect and/or repetitive lifting or twisting
- Aging; discs gradually dry out, losing strength and resiliency
- Obesity, lack of regular exercise, tobacco use
The majority of disc herniations do not require surgery. Pain associated with herniated disc often resolves within 4-6 months. There are many non-surgical treatments to help relieve symptoms. These include:
- Medications such as an anti-inflammatory to reduce swelling and pain, muscle relaxants to calm spasm, and narcotics to alleviate acute pain
- Epidural corticosteroid injection(s) may help relieve significant radiating pain in the arm or leg
- Physical therapy, which may include massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function
For those that do require herniated disc surgery, Microdiscectomy has a multitude of benefits. Click here to learn more.
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Dr. Stieber formulates a treatment plan based on your symptoms. If your condition is steadily improving, conservative treatment may be all that’s required. If your condition continues to deteriorate, surgery may be the best treatment option.
A Laminotomy and discectomy is the standard surgical procedure for treatment of a lumbar herniated disc. The surgeon removes a small portion of the bone to gain access to the spinal canal (laminotomy) and then removes the portion of herniated disc (discectomy). In certain cases, spinal fusion may be required.
For patients with a lumbar disc herniation requiring surgical treatment, Dr. Stieber offers the most advanced minimally-invasive treatment options using extremely small incisions and allowing outpatient treatment. Tubular microdiscectomy involves the use of a robotic microscope to remove the offending herniated disc through an incision of 16-18mm. Endoscopic discectomy utilizes a specialized camera inserted into the spinal canal through a ¼ inch incision and dedicated instruments to treat the damaged disc. Potential advantages of these minimally-invasive approaches include decreased pain, quicker recovery, and an enhanced cosmetic result.