Herniated disc
Disc herniations are common and can be treated with both surgical and non-surgical therapies. If experiencing symptoms of lower back pain that radiates down the buttocks and leg, or neck pain radiating down the arm, you may be suffering from a disc herniation. If symptoms include numbness or weakness in the arm or leg, consult your physician immediately. You do not have to live in pain.

What is a herniated disc?

A herniated disc is a common injury that occurs when the soft nucleus of an intervertebral disc pushes through the tough outer annulus. Often, disc herniations occur in the lower region of the back known as the lumbar spine. This rupture of a vertebral disc can be caused by the normal wear of aging or by traumatic injury. A herniated disc can push against a nerve root, sending pain down the sciatic nerve and resulting in a burning, tingling and/or numbing sensation from the lower back down to one or both feet. Fortunately, many surgical and nonsurgical treatments are effective at eliminating symptoms associated with a herniated disc. Dr. Bray and his clinical network offer a wide range of soft tissue, pain management and microsurgical options for the treatment of disc herniation.

Intervertebral discs are a major anatomical component of the spine. Functionally they are responsible for absorbing impact in the spine, preserving mobility, and maintaining the spacing between vertebrae (the bony structures in the spine). An intervertebral disc maintains its shape via the tough outer cartilaginous annulus. The inner region of the disc (nucleus) is far more fluid, giving the disc its shock absorbing capacity. It may help to envision an intervertebral disc as a thick rubber waterbed full of viscous fluid.

Repeated trauma and the natural process of aging may cause the annulus to break down. If sufficiently worn, the nucleus will begin to push through the annular cartilage. The annulus is innervated by sensory nerve endings and therefore annular tears are often painful. Additionally, breakdown of the annulus results in local inflammation.

If the nucleus completely pushes through the annulus, it is said to herniate out of the normal disc space. The adjacent spinal cord and extending nerve roots may be compressed by herniated disc material. Spinal cord or nerve root compression often results in pain radiating down the arm, or leg, depending upon the location of the disc herniation. Many patients are familiar with the condition known as sciatica – pain in the lower back, buttocks, and back of the leg. This is often the result of a lumbar disc herniation compressing a nerve root. Treatment plans vary depending on the health of the patient and the state of the disc.

What causes disc herniations?

Intervertebral disc herniations are common, as the annulus dehydrates and loses strength naturally as one ages. Certain lifestyle choices, such as frequent sitting, occupations that require repetitive motions, improper weight lifting, and smoking may all increase the likelihood to suffer from a herniated disc.

What is the difference between a bulging disc and a herniated disc?

A herniated disc occurs when the soft interior of the intervertebral disc (the nucleus) pushes through the outer annulus. This creates a concentrated source of pressure on a particular portion of nerves.

A bulging disc is the protrusion of a large section of intervertebral disc, and is not the result of a complete annular tear. In an MRI, a bulging disc will appear “squashed” between two vertebrae, similar to a hamburger patty that is too large for the bun. Another common term for this condition is a “slipped” disc.

Conservative Treatment Options

If experiencing problematic lower back pain that radiates down the leg, or consistent pain in the arm, consult your physician. A physical examination, neurological examination, and imaging techniques will reveal definitively if symptoms are the result of a herniated disc.

The majority of patients find relief through non-surgical therapies. Often, herniated Discs heal naturally. This process is greatly aided by soft tissue treatment and targeted strengthening such as Med-X. Many patients find relief through traditional eastern medicine such as acupuncture. Three to four months of physical therapy is typically recommended. Intense pain and muscle spasm should be addressed with adequate bed rest while maintaining a light walking regiment. Anti-inflammatory medications are often prescribed to help with pain and local inflammation of damaged tissues. In certain cases pain management may include corticosteroid injections to allow physical therapy to continue.

Surgical Intevention

If non-surgical approaches are insufficient, surgical options are highly successful. In cases where the herniation is affecting functionality, presents a clear danger to the long term health and of the patient, or is drastically effecting quality of life, minimally invasive spine surgery provides patients a means of effective long term relief. DISC offers a full range of treatment options, with physicians working together to find the best course of action for the patient.

  • Lumbar microdiskectomy: This is the most common procedure for a herniated disk in the lower back. A microdiscectomy is a minimally invasive procedure that carefully removes damaged sections of an intervertebral disc that are putting pressure on the spinal nerve, as well as inappropriate bone formations in the area. Normal activities can generally be resumed six weeks after a microdiscectomy. Dr. Bray performs microdiscectomies on an outpatient basis, with most patients returning home the same day of surgery.
  • Cervical diskectomy and fusion: Cervical diskectomy is an outpatient procedure for the herniated disk in the neck. To relieve pressure, the entire herniated disk is removed. Bone is placed in the disk space and a metal plate may be used to help support the spine.

A disk begins to herniate when its jelly-like nucleus pushes against its outer ring due to wear and tear or a sudden injury.

The normal anatomy of the lower spine (side view). The close-up shows a cross-section view of a healthy intervertebral disk.

There are many surgical and non-surgical therapies to alleviate symptoms caused by a herniated disc. Dr. Bray and the team at DISC routinely treats herniated discs, helping each patient rapidly return to an active, dynamic lifestyle.