Herniated Disc
A herniated disc typically occurs when a degenerative disc breaks down, causing the disc to herniate, or protrude. This may result in pressure on or inflammation of the nearby nerves.
What’s in this section?
Signs and symptoms
Symptoms depend on the location of the herniated disc.
Lumbar disc herniations can cause the following symptoms:
- Sciatica
- Burning, tingling, numbness and pain in the leg or buttock
- Typically one sided
- Sharp pain
- Lower back pain
Cervical disc herniations can cause the following symptoms:
- Pain in the neck or between the shoulder blades
- Radiating pain down the arms
Diagnosis
Diagnosis of a herniated disc starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose this condition, including x-rays , computed tomography (CT), magnetic resonance imaging (MRI) or myelogram .
Treatment options
There are a few treatment options for a herniated disc:
- Medication to reduce pain.
- Physical therapy to strengthen the area around the disc.
- Epidural steroid injections. This procedure is used to inject a steroid and a local anesthetic into the space around your spine to help decrease inflammation and swelling, typically leading to improvement in pain in your neck, arms, back and legs. It is performed in either the office or surgery center setting. This procedure typically takes just a few minutes and may be performed either with just local anesthetic or IV sedation in the surgery center, depending on patient preference. Most procedures involve a needle that is advanced to the target area using fluoroscopic (x-ray) guidance. A small amount of x-ray contrast will be injected to confirm accurate placement. Once the needle has been properly placed, a combination of a local anesthetic and/or injectable steroid will be placed into the targeted area.
- Herniated disc resection. You will be positioned face down on a padded frame/bed. By opening the skin and muscle layers, the spine is exposed. Either part of the roof (laminotomy) or the entire roof (laminectomy) is performed, depending on how much exposure is needed for the operation. When surgery is done, the retractors are removed, allowing the muscles to cover the exposed canal, and the skin is closed.
- Minimally invasive discectomy/decompression. During surgery, a small incision will be made. Your surgeon will remove bone and ligament to get access to the spinal canal. Using a microscope, the nerve will be identified, and the pressure from will be taken off by removing disc material. During this surgery, no fusion will be performed. Surgery usually takes 1 – 2 hours and typically you go home the same day.
- Disc decompression and fusion. An incision is made, depending on the location of the disc. The tissue surrounding the disc is dissected until the spine is seen. We remove the disc starting superficially, then deeper in the joint space until we work all the way through the joint and enter the spinal canal, where the bone spurs or disc herniation compresses the nerves. We remove the compressive pathology very carefully, as the nerves that are in that area are very delicate. After we get all of the pressure off of these delicate nerves, we then reconstruct the joint using an implant of cadaver bone or a cage made of synthetic materials. A metal plate and screws then are secured to the front of that part of the spine so that the bones of that segment will heal/fuse and remain stable. The wound is closed with stitches under the surface that dissolve after the skin has healed.
- Artificial disc replacement. An incision is made and the tissue planes are separated until the surgeon gets down to the spine. The disc is then removed slowly in small pieces and the pressure is pulled away from the spinal cord and/or nerve roots. An artificial disc, which can be made from many different materials depending on the manufacturer, is put into the space where the disc once was. This artificial disc has to be precisely placed so that it provides similar motion to the original disc.
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