Herniated Disc

Herniated Disc
What is a Herniated Disc?
Treatment Options
Recovery Time
Level of Activity after Treatment

What is a Herniated Disc?

To better understand disc herniation, let’s review some basic concepts. The vertebral bodies are the bony components of the spine, which are stacked on top of each other to give us our height. The structure in between the bony components, is the intervertebral disc, or disc, for short. The disc is a complex structure, allowing motion in the front part of the spine, cushioning the adjacent vertebral bodies. By virtue of its function, the disc experiences significant sheer and rotational forces during our daily lives. The main elements of the disc are able to respond effectively to these continual forces. After trauma to the disc, the damage is usually seen as a tear in the back of the disc radial fibers (annulus fibrosis) which causes weakening of the shell of the disc. If the tear is not healed, or extends to the inner part of the disc (nucleus polposus), the center portion of the disc can extrude (herniate) through the tear, and reach the important structures that live behind the disc (i.e. spinal cord and/or nerve root).

Symptoms of a Herniated Disc: Presentation and symptoms could vary greatly. Most patients complain of back pain and often “hear a pop” in their back. Back pain tends to move across the lower back, it’s usually burning, throbbing and grabbing. Back pain may remain or change into buttock pain. Sitting is usually worse than standing, and while sitting, tilting to side tends to diminish the pain. Although it could be the initial symptom of the ruptured disc, leg pain happens in a delayed fashion. Leg pain can be severe, and prevents the individual from walking or sitting straight.

Causes of a Herniated Disc: Weakening of the outer shell of the disc predisposes the centeral part of the disc to extrude out and compress the nearby nerves (pinched nerve) or spinal cord.

Diagnosis of a Herniated Disc: Diagnosis may be clinical, meaning that your physician may initially treat the presenting pain with anti-inflammatory medications, muscle relaxants and pain killers. If symptoms persist or worsen after an intial trial period, primary doctor or chiroprator may refer the patient or the individual patient may seek a specialist for further evaluation. MRI imaging is a routine imaging tool in diagnosis of herniated disc. Together with the findings on your physical examination, the spine specialist is able to offer you a diagnosis and explanation as to the cause of your symptoms and pain.

Treatment Options

The goals of treatment are to relieve pain and preserve function. Most patients with lumbar herniated disc experience initial back pain, described as burning sensation in the small of the back. Sometimes acutely, but more commonly in a delayed fashion, the individual experiences shooting pain in the leg, followed by cramping in the muscle, pins and needles, and “charlie horses.” Generally, pain is worse at night and sitting is worse than standing. In some instances, the shooting pain can be replaced with numbness and eventual weakness in the leg. It is not uncommon for the individual to experience urinary frequency and urgency. Majority of patients present to their primary doctors and are treated with anti-inflammatories, muscle relaxants and narcotics. Bedrest is generally tried only for a few days. Back bracing only for short duration may be prescribed. Majority of patients do respond favorably to these maneuvers, but if you continue to experience shooting pain in the leg, numbness, weakness or urinary symptoms of urgency, you should consult a specialist. In case of loss of urinary control (incontinence) you should go to the nearest emergency room for an urgent evaluation. In case of failure of initial conservative care, you need to be evaluated with imaging studies. The imaging modality of choice is a lumbar MRI to evaluate the extent of the disc herniation. At this point you are best served by having a spine specialist evaluate you. You may be offered different types of treatments depending on your individual presentation, MRI finding and clinical examination. Annular repair is a new technology that allows the surgeon to repair the point of disc rupture during the surgery. Dr. Mohamed Mohi Eldin has used the annular repair technique successfully to reduce the chance of disc reherniation.

Recovery Time

In case of surgical intervention, you may need a lumbar microdiscectomy. With the advent of microscopic techniques, most patients are able to go home after six to eight hours in the recovery room. Driving is limited for the first two weeks. Most patients with non-labor intensive jobs, are able to return to work in 3 to 4 weeks.

Level of Activity after Treatment

During the first two weeks following the procedure, you are asked to avoid bending, lifting and twisting. Most patients are asked not to engage in high impact exercises, such as running, skiing, or snowboarding for about three months. With the use of annular repair, patients will have less chance of disc reherniation during the recovery period. Ask Dr. Mohamed Mohi Eldin during your visit if this is an option for you.

Why Select Dr. Mohamed Mohi Eldin?