Herniated Disc

HERNIATED DISC

WHAT IS A HERNIATED DISC

Discs are made out of cartilage and separate the bones of the spine. They work really well as shock absorbers to protect your nerve roots and spinal cord from activities with impact, like running. Disks have 2 parts. The outer part is really strong, the inner part is softer. It sounds weird, but the inner part is about the same consistency as crab meat, while the outer part is like Gore-Tex. The outer part of the disc dries out over time, and ultimately can tear. Once the outer part is torn, the inner part is free to move through it. “Herniated” means an abnormal protrusion. In a herniated disc, the soft inner part of the disc protrudes through a tear in the hard outer part.

SYMPTOMS OF A HERNIATED DISC

Herniated discs cause several different kinds of pain. Just having a tear in the disc and cause a backache, like a knife in the back. This can go on for years without herniation. The herniation itself usually causes a burning, achy sensation off to the side of the low back with tingling or electrical shock like feelings going down the leg. The pain down the leg is called Sciatica.

CAUSES FOR HERNIATED DISCS

Herniated discs are common, and they come about in a variety of ways. There can be a long delay between the tear and the herniation, or they can happen all at once. In the major fall, or a big car accident, discs are often torn and herniated at the same time. In other cases, an injury causes the tear, and then days, months, or years later a minor move like a cough, sneeze, or stepping off a curb causing the herniation.

There is a ligament right next to your discs. If the herniated disc material doesn’t make it all the way through the ligament, is called a bulging disc. If it breaks through, it’s often called a herniated disc, or free fragment. Honestly, it usually doesn’t make much difference. Both types can be really painful. Slipped disc is an older term, which most people really don’t use any more.

TREATMENT FOR A HERNIATED DISC

Sciatica is really severe, scary pain. However, most people will get better on their own without the need for further treatment over days to weeks. The best treatment for pain from a herniated disc depends on how long you’ve had it. In the first six weeks, the best thing to do is light activity, and take Tylenol. If that isn’t strong enough, you can try ibuprofen (2 tablets every 8 hours with food) and Prilosec (one tablet a day). You can consider acupuncture or chiropractic treatment. Braces and exercise don’t work well in this phase. Narcotics and muscle relaxants should be avoided. If the leg pain is causing numbness or weakness, then get an MRI; most of the time it’s not needed for most people in this phase. If an MRI was done and shows a herniated disc, then one epidural injection is a good idea. But the main thing is to stay active. Get back to work ASAP.

If you are still having pain after six weeks, then MRI and an epidural, if appropriate, make sense. Physical therapy is also a good idea in this phase. If 12 weeks have gone by and you still have the pain is probably something structural. This is the time to see a surgeon. In nine cases out of ten it never comes to that. Most of the time back pain and sciatica due to a herniated disc are scary, but they get better on their own. Hang in there. But please remember, if you have a history or cancer, night sweats, unintentional weight loss, or you can’t pee you can’t wait. You need to be evaluated right away by a doctor.

APPROACH TO A HERNIATED DISC

At outpatient surgery centers, surgeons use a minimally invasive approach for the removal of herniated lumbar disks. A small, approximately 1/2 inch incision, is made in the low back. Using a fluoroscope, they place a tubular dilator over the lamina bone, which covers the spinal canal. Operating through microscope, they shave off a small amount of the lamina bone, retracted nerve root, and then remove the disc material under direct vision. In most cases the surgical part of the operation takes 30-45 min. They expect their patients wake up with some pain in the back, but without there radiating pain in the leg.