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What is Herniated Disc?
An intervertebral disc has two main parts: an outer shell of fibrous cartilage (the annulus fibrosis) and an inner filling of a jelly-like material (the nucleus pulposus). The outer wall of an intervertebral disc can become weakened for a variety of reasons. As people age, the fibrous material becomes more brittle. Excessive strain can rupture the annulus fibrosis. Poor diet and exercise habits can also weaken the disc.
Regardless of the cause, once the tough shell of the disc is weakened or cracked, the soft gel of the nucleus pulposus can deform the disc. Once deformation occurs, the disc may irritate or pinch one or more spinal nerves, causing pain.
What are the symptoms of Herniated Disc ?
Herniated spinal discs can cause a range of symptoms. The particular herniated disc symptoms you experience will depend on factors such as the location of your damaged disc and the amount of pressure your disc material places on your spinal cord or spinal nerves.
Location and Severity
Since the spinal canal in your cervical spine (neck area) provides passage for your spinal cord, a cervical disc herniation can cause problems by intruding upon your spinal cord or your spinal nerve roots.
Herniation in one of the thoracic discs in your upper back can also affect your spinal cord or nerve roots, although most people don’t develop symptoms originating in this part of the spine.
If damage is located in one of the lumbar discs in your lower back, you may experience mild to severe problems stemming from intrusion upon one or more of your nerve roots. As a rule, the worst herniated disc symptoms appear in people who experience the greatest amount of excess pressure in sensitive spinal locations.
Possible problems stemming from a herniated spinal disc include discogenic pain, sciatica, the appearance of unusual nerve sensations (e.g., numbness and tingling), unusual weakness in the muscles linked to affected nerves and a medical emergency called cauda equina syndrome.
Discogenic pain sometimes refers to pain that originates within a damaged spinal disc; it can also refer to sciatica or other painful body changes that occur when a disc impinges on nearby nerve tissue.
Along with pain, unusual numbness and tingling occur when the pressure placed upon nerve tissue interferes with the strength of the signal that connects any given nerve to the central nervous system.
Unusual muscle weakness, which typically appears in the lower body, also has its origins in interference with normal nerve signal strength. Cauda equina syndrome is a specific, severe result of nerve pressure in the lumbar spine. If a person affected by this syndrome doesn’t receive rapid medical attention, he or she can experience permanent damage in the affected area(s) of the body.
How is Herniated Disc diagnosed?
Although you may believe that you have the symptoms of a herniated disc, the only way you can tell for sure is by getting a diagnosis from a doctor.
A herniated disc is the result of destructive changes that lead to a rupture in the outer lining of the disc and subsequent leakage of the soft interior that gives the disc its cushioning value. Pressure produced by this leakage can trigger problems by interfering with the normal function of your spinal cord or one of the nerve roots that pass from the spinal cord to your body.
Symptoms associated with disrupted nerve or spinal cord function include pain in or near the affected area, pain that radiates away from the affected area, and changes in your nervous system that manifest as weakness, tingling or numbness. However, all of these symptoms have other potential causes and it’s difficult to tell on your own what’s causing your particular problems.
Initial Diagnosis of a Herniated Disc
In the first phase of a herniated disc diagnosis, your doctor will ask you questions about your medical history and perform a basic physical exam to test the sensitivity of your back and other affected areas. In some cases, you will also undergo a more targeted exam that tests aspects of your nerve-related health, such as your ability feel sensations in your skin and the relative strength of your muscles. While some doctors complete their diagnosis at this stage, others confirm their findings with an advanced imaging diagnostics.
Diagnostic Procedures for a Herniated Disc
An MRI scan is a critical tool in diagnosing the causes of all significant back problems because it gives doctors the ability to fully visualize all of the important structures involved, including both bone and soft tissue. With this finely detailed information, your physician can make a more accurate diagnosis of your current problems and also get a better overall picture of the factors affecting your general back health. In turn, these findings make it much easier to provide back pain treatment that is targeted specifically to your situation.
Other imaging tests that may supplement an MRI scan during the diagnosis of a herniated disc include two X-ray-based procedures called a CT scan and a myelogram.
Limitations of Imaging
Much like a crime scene, it’s important not to assume that the usual suspects are the actual culprits in your pain. An MRI may indicate a bulging disc, but it’s possible that the bulging disc is not causing any symptoms at all – in fact, it’s common for older people to have bulging discs, and in many cases they don’t cause pain. The pain could, in fact, originate from a different source such as another bulging disc, scar tissue from a previous surgery, a bone spur, or even spinal arthritis.
What are the causes of Herniated Disc?
It’s not always possible to determine exactly what caused a herniated disc, although the most likely causes are well-known.
Spinal Degeneration and Herniated Discs
Each disc in your spine is positioned between two spinal bones (vertebrae) and contains a soft, pliable center surrounded by a tough, resistant outer coating. Most people develop disc-related problems like degenerative disc disease as a result of the natural, age-related degeneration that leads to a weakening of a disc’s outer layer. This weakening, a result of simple wear and tear, makes it relatively easy for the outer coating to tear (herniate) and inner material to escape, pushing against the spinal cord or one of the nearby nerve roots.
Unfortunately, the discs in your back tend to rupture earlier rather than later in the degeneration process. This means that wear-and-tear-related damage is far more likely to occur than any other cause of a herniated disc. Because of the typical stresses on the human back, most cases of natural disc degeneration will appear in either the cervical spine (your neck) or the lumbar spine (your lower back).
Since degeneration is a gradual process, these herniated discs also tend to proceed in stages. First, an affected disc will lose some of its moisture content and some of its ability to properly cushion your back. Next, the disc will start to lose its normal shape as a protrusion forms in a weakened segment of the outer layer. The following stage of herniation involves the actual rupture and release of the inner-disc material. In the final stage of herniation, the material that escapes from a rupture spills out into the surrounding area and presses against or irritates nearby nerve tissue.
Physical Causes of Herniated Discs
Herniated discs may also appear in the aftermath of certain types of back trauma. For example, if you get into a car wreck or any other form of accident, the forces involved can directly or indirectly place excessive strain on a disc and produce a rupture that allows inner material to leak out into your spine.
You can also herniate a disc in your back while participating in sports, exercising or performing everyday actions that subject your spine to excessive pressure. Actions known to cause problems include lifting heavy objects improperly (using your lower body and keeping your spine straight), or twisting your torso past its normal point of maximum flexibility.
Some herniated discs are the result of a combination of age-related disc degeneration and the undue stress produced by accidents or other forms of physical trauma. In these circumstances, pre-existing problems with your spinal disc health can lower the amount of force required to trigger a rupture. If your disc degeneration has advanced far enough, even relatively minor pressure on your spine can be a deciding factor in herniation.
Genetic Herniated Disc Causes
Some people may have genetic risks for weak spinal discs that they inherit through their family bloodlines. If your family has a history of herniated discs, you may have this tendency as well.
If you do, then you have a built-in, potential herniated disc cause that will make you unusually susceptible to back pain and problems as you grow older.
What is the treatment like for Herniated Disc?
While many people with herniated disc conditions can find relief from fairly basic herniated disc treatment options, some individuals require surgery to heal their damaged discs.
A diagnosis of a herniated disc does not necessarily mean you must have surgery. It is important to try non-surgical treatment options first. The use of lifestyle changes (such as proper posture), physical therapy, and the use of props such as a specially-designed pillow may provide a great deal of the comfort you’re searching for. Patients also look into chiropractic therapy, doctor-approved exercise including yoga or stretching, massage, and even acupuncture.
Before herniated disc surgery, most patients try a nerve block such as an epidural steroid injection (ESI). An ESI combines a painkiller with a steroid to help reduce the swelling of the herniated disc. The ESI may significantly reduce the pain for a temporary period, or even eliminate the pain. If these non-surgical treatments fail to provide relief, then a procedure may be the next best step.
Surgical Treatment of Herniated Discs
For many years, traditional open back surgery for a herniated disc involved a large incision multiple inches long, allowing the doctor to access the spine with tools such as a scalpel. Such a procedure has been considered a last alternative, since open back surgery can lead to a long, painful recovery period and increased risks including infection and scar tissue. Fortunately, the increased use of imaging and endoscopic tools (long, thin tools that can be operated “remotely”) has allowed doctors to view and treat a herniated disc using a small incision. Today, this is known as minimally invasive spine surgery.
Traditional Minimally Invasive Spine Surgery
Minimally invasive spine surgery has been around since the 1980’s, and has become increasingly popular as a treatment for herniated discs. The approach offers many benefits including reducing the need for an overnight hospital stay, creating a small incision that needs only a stitch or band-aid, and minimizing trauma and scar tissue by reducing the amount of healthy tissue, muscle that needs to be cut to access the spine.
Minimally invasive spine surgery is still not as simple as a band-aid, however. It’s still necessary for multiple tools to reach the herniated disc which is “hiding” inside the spinal canal. The incision will be made at the spine level, and side, where the main pain cause is expected to be. To reach the canal, it is necessary for the physician to stretch the incision and insert a large catheter (tube) holding the tools including a camera, bone drill, incisors, and scalpel. He will often cut healthy tissue and tear muscle to reach the spine, then drill the bone to access the canal. The physician will then use either a scalpel or laser to remove the portion of the herniated disc that is pressing against the nerves and causing pain.
Due to the nature of degenerative disc disease, many patients have bulging or herniated discs at multiple levels of the spine. In this case, the physician may need to perform a separate procedure for each level and side.
The thoracic and cervical procedures treat herniated disc pain in the upper back and neck, using a slightly different approach. In these procedures, the physician identifies the source of pain using live imaging, then inserts a hollow needle containing a laser. The laser fires short bursts of heat in strategic points in the disc, to shrink the disc bulge and seal tears. The use of the hollow needle reduces the need to create a large incision, or damage bone, to access the disc herniation. This means the patient has less pain during recovery, and less need for a spinal fusion to stabilize the spine.
Laminectomy and Laminotomy
Another common form of herniated disc surgery is the laminectomy and its less invasive cousin, the laminotomy. The lamina is part of the bone in the spinal canal. In some cases of a herniated disc, the physician may believe the best way to relieve the pressure on the nerve (causing pain) is to remove part or all of the bone in that area, giving the bulging material more space to expand. In a lamintomy, a minor portion of the lamina is removed; a laminectomy involves the removal of a larger section of bone.
A laminectomy and laminotomy may be combined with a discectomy to remove part of the herniated disc, and also a procedure to stabilize your spine and prevent problems associated with the new gap in your spinal column.
Which Treatment Is Best?
In your case, it may not be obvious which treatment is best. As a rule, doctors will recommend that you try the least invasive treatments first. However, your diagnosis may indicate that you have a condition that may require a spinal fusion at some point. In this case, many patients may think that they should simply undergo the spinal fusion immediately, instead of trying smaller treatments first.
The solution is not so simple. Consider this: since a spinal fusion replaces a flexible vertebral disc with a hard rod and screws for stability, it often adds strain to the spine levels above and below it, potentially speeding disc degeneration and ironically, related disc herniation. For this reason, your doctor may say that you may need additional spine surgery several years after such a procedure – and for that reason, a fusion is often considered a last resort. As an alternative, a minimally invasive procedure may be able to provide the pain relief you need, allowing you to delay more aggressive surgery. As an added benefit, minimally invasive spine surgery allows you to get back to light activities within days – much faster than a spinal fusion recovery.
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Incisions made are 5 millimeters or less in length, allowing for minimal scar tissue and less infection risk