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A herniated disc may also be referred to as a ruptured disc, bulging disc, and disc herniation (sometimes also spelled disk). Regardless of the nomenclature, a herniated disc most commonly presents as a radiculopathy. Radiculopathy is pain, numbness and / or weakness in a certain nerve distribution. The disc itself is composed of two parts; annulus fibrosus and nucleus polposus. The nucleus is a gelatinous like material that is normally hydrated and is found in the central portion of the disc. The annulus is a thick avascular outer covering of the disc that contains the gelatinous central portion. When a disease process affects the integrity of the annulus, the gelatinous central material may escape or herniate into the spinal canal and cause compression to the nerve root (radiculopathy), spinal cord (myelopathy) or both (myeloradiculopathy).
Signs and Symptoms of Herniated Discs
Common signs and symptoms of herniated discs include: moderate to severe electric shock pain, tingling and numbness, muscle weakness, and bowel or bladder problems. The pain pattern depends on where the disc herniation is located. For example, when a disc herniation happens in the cervical spine (neck) region, it usually manifests as intense arm pain , numbness and or weakness, whereas when a disc herniation occurs in the lumbar spine (low back) region, mild or extreme pain radiates to the buttocks or down the legs and may be associated with weakness in the legs.
Herniated Disc Diagnosis
The goal of radiculopathy treatment is to resolve the underlying cause and restore the nerve root to a normal function. Depending on the type of radiculopathy and severity of the patient’s health condition, a number of treatments may be considered to provide symptomatic relief and a better quality of life. In many cases, conservative (non-surgical) treatment may be pursued, which can consist of rest, patient-specific exercises, weight loss, and medications in the form of oral prescriptions or injections. Patients who do not respond well to conservative treatment may be candidates for minimally invasive spinal back surgery, involving disc implants or vertebral fusion. Your physician will help you decide what radiculopathy treatment is best for you and your condition.
Treatment of and Surgery for Herniated Back or Neck Discs
When a disc herniation happens in the low back and causes leg pain it is generally treated without an operation. Several studies have shown that up to 90 percent of people presenting with a disc herniation will have symptoms resolve non-operatively within 6-8 weeks. Operative intervention is usually reserved for those patients that failed non-operative treatment. A lumbar discectomy is a reliable surgery that generally yields excellent results in terms of alleviation of leg pain that is caused by a herniated disc. Generally lumbar disc herniations are treated from a posterior approach. There are several techniques for lumbar discectomy and when tailored to the individual patient, generally have an excellent outcome. Minimally invasive discectomy and microdiscectomy as well as open discectomy all may be specifically tailored to the individual patient. At University Spine Associates, the vast majority of patients who require an operation for a lumbar herniated disc, have the surgery done as an outpatient (going home on the same day as the spine surgery).
Cervical spine (neck) surgery is generally reserved for patients who do not respond to non operative treatments for more than 6 weeks to three months. Depending on the location of the disc herniation several surgical options are available. Anterior cervical discectomy is an operation that is done from the front of the neck and is usually accompanied by an anterior cervical fusion or possibly cervical artificial disc replacement. Cervical disc herniations may also be approached from a posterior approach with an operation that is called a posterior cervical foraminotomy. A cervical foraminotomy is done with a minimally invasive approach using tube retractors and a microscope offers a great alternative to the traditional anterior cervical discectomy and fusion (ACDF) when applied appropriately.
It is important to have all the newest and traditional tools available to both the patient and the spine surgeon in order to maximize the success of the treatment. It is imperative that patients seek the advice of a board certified and fellowship trained surgeon, whose expertise are dedicated to the treatment of spinal conditions. |
