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Herniated Disc

You may have heard of this condition colloquially referred to as a “slipped disk”. This is, however, an incorrect and misleading description. Your intervertebral discs cannot actually “slip” as they grow together with the adjacent vertebrae. The disc can twist, bulge or rupture, but it can never literally slip out.

And that is what a herniated disk actually is, a rupture in one of the fibrous rings that separate your vertebrae. This tear and the resulting protrusion of the soft, central portion of the disc can cause minor to severe and unrelenting pain. If the herniation occurs in the lumbar region, it can even cause sciatica.

This condition is most commonly the result of spinal degeneration that is simply a result of growing older, but can also be caused by injury or repetitive stress on the back.  Minor herniations usually fix themselves within a couple weeks. Severe herniations will require treatment, and surgery in some cases.

Herniated discs can occur anywhere in the spine but are most common in the lower back or lumbar region. Many of the ways to treat herniated disks do not require surgery. Contact the Ainsworth Institute of Pain Management to explore all treatment options.

What is a Herniated Disc?

Screen Shot 2015-09-09 at 12.51.24 PMThe spinal column consists of a stack of vertebrae separated by discs, which cushion the forces on the spine and prevent the vertebrae from grinding against each other. These discs are made up of a ring of tough fibers (called the annulus fibrosus) protecting an inner capsule filled with a gel-like substance called nucleus pulposus. The annulus fibrosus holds the disc in place while the nucleus pulposus acts like a shock absorber.

A herniated disc is one in which the disc bulges and then ruptures or breaks open. This can cause the disc to change shape, shifting the spinal column and possibly compressing nearby nerves. The gel-like substance inside the disc may leak out, which can irritate the nerves. This can cause mild pain (no nerves are compressed) to mild or severe pain, depending on the extent of the nerve involvement.

Learn More About Spinal Discs

What are the Symptoms?

shutterstock_181111394  Pain which is made worse by movement
 Pain and numbness on one side of the body
 Muscle spasms
 Weakness
 
Pain extending through arms and legs

As mentioned above, if the herniated disc occurs in the lower back, there may be leg weakness, loss of leg function, or sciatica. Sciatica causes a burning, tingling, or pain that extends from the lower back over the buttocks and down the leg.

A herniated disc in the neck or cervical region can cause headache in the back of the neck.

What are the Causes?

A herniated disc usually occurs in older adults naturally, as a result of spinal degeneration. Other causes of disc herniation include:

 Obesity
 Sedentary lifestyle
 Tobacco use
 A blow or excessive force to the spine (such as a severe fall or vehicular accident)
 Injury caused by lifting something improperly or twisting the back
 Repetitive stress on the back

How Do You Diagnose a Herniated Disc?

Diagnosing a herniated disc is relatively easy.  Most diagnoses are made through a combination of medical history, physical exam and then confirmed with certain diagnostic tests like:

 CT or MRI scan
 Myelogram (a contrast scan)

While these tests will confirm the presence of a herniated disc, they cannot tell which is the cause of the pain.  Most people have herniated discs with no pain whatsoever, so a simple scan is of no use in finding which disc is the problem.  That’s where a discogram becomes useful.

Discogram – A very small amount of contrast dye is injected into a herniated disc to pressurize it.  When the dye is injected your doctor will know with reasonable certainty if that disc is the cause.  More importantly, the dye will take the shape of the inside of the disc and outline any tears or imperfections within.  This is not possible with even the most advanced MRI.

What are my Treatment Options?

shutterstock_124145977Treating a herniated disc DOES NOT ALWAYS REQUIRE SURGERY.  In most cases, the pain from a herniated disc will resolve on its own in a matter of weeks to months.  Surgery on the other hand can cause more pain as well as potentially causing scar tissue to develop in and around the spinal cord which is irreversible and causes worse pain to develop.  When formulating a recovery plan, there are a number of conservative treatments that are typically recommended first.  These usually include a combination of the following:

 Rest
 Medications to reduce pain, reduce inflammation, and relax muscles
 Physical therapy
 Special exercises
 Braces to support the spine
 Traction

Interventional Pain Management Treatments

While some cases of disc herniation resolve spontaneously, many do not.  Sometimes, patients simply do not want to wait weeks or months for the pain to subside.  The disc will never “un-herniate” or go back to normal, so there is always the potential for pain to return at any moment.  That is where interventional pain management comes in.  If the pain persists beyond 6 weeks, it is likely it will continue without an interevention.

Lumbar Epidural Steroid Injection – This procedure is considered a very effective treatment for back pain. It is basically the same treatment a woman will receive during childbirth to eliminate pain.  Under fluoroscopic guidance, your physician will place a small needle into the epidural space and inject a small amount of medication to eliminate the pain.

Transforaminal Epidural Steroid Injection – This procedure is similar to the one above; however, in this case the medication is focused directly onto the nerve fibers that make up the sciatic nerve – the result is more medication delivered to the affected area.

Biacuplasty – This procedure uses a type of radiofrequency ablation (RFA) inside degeneratve discs to heal painful nerves.  This is an outpatient procedure and takes just minutes to perform.

Spinal Cord Stimulation (SCS) – When the inflammation in and around the affected nerves is too great for an epidural injection, SCS is an excellent and effective treatment option that can eliminate the pain without surgery. In SCS, an electrical pulse is delivered directly to the spine, blocking certain neuron fibers’ access to the brain and consequently the brain’s ability to sense the previously perceived pain. 

Microdiscectomy – Another option in cases where the inflammation in and around the affected nerves is too great for an epidural injection.  With microdiscectomy, some of the damaged material around the nerve(s) is removed.

Surgery:
Some herniated discs will persist even after all the above procedures are tried.  In cases like these, surgery may be the only option.  Discuss the risks and benefits of potential surgical options with the physician.  Surgery should be considered a last resort.

Schedule an Appointment Today

Our doctors at the Ainsworth Institute of Pain Management are experts in using the most cutting edge and advanced methods for treating spinal disk herniation. Call and schedule an appointment today with one of our board-certified pain management doctors and find out what treatment options would best suit your symptoms.

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