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Herniated Disk Repair

A herniated disk or disc (also called slipped disc) occurs when all or part of a disk in the spine is forced through a weakened part of the disk. This places pressure on nearby nerves.

Causes of Disc Herniation

The bones (vertebrae) of the spinal column protect nerves that come out of the brain and travel down your back to form the spinal cord. Nerve roots are large nerves that branch out from the spinal cord and leave your spinal column between each vertebrae.
The spinal bones are separated by disks. These disks cushion the spinal column and put space between your vertebrae. The disks allow movement between the vertebrae, which lets you bend and reach.

• These disks may move out of place (herniate) or break open (rupture) from injury or strain. When this happens, there may be pressure on the spinal nerves. This can lead to pain, numbness, or weakness.
• The lower back (lumbar area) of the spine is the most common area for a slipped disk. The neck (cervical) disks are affected a small percentage of the time. The upper-to-mid-back (thoracic) disks are rarely involved.

 

Radiculopathy is any disease that affects the spinal nerve roots. A herniated disk is one cause of radiculopathy. Slipped disks occur more often in middle-aged and older men, usually after strenuous activity. Other risk factors include conditions present at birth (congenital) that affect the size of the lumbar spinal canal.

Symptoms of Herniated Disk

Low back or neck pain can feel very different. It may feel like a mild tingling, dull ache, or a burning or pulsating pain. In some cases, the pain is severe enough that you are unable to move. You may also have numbness. The pain most often occurs on one side of the body.

• With a slipped disk in your lower back, you may have sharp pain in one part of the leg, hip, or buttocks and numbness in other parts. You may also feel pain or numbness on the back of the calf or sole of the foot. The same leg may also feel weak.
• With a slipped disk in your neck, you may have pain when moving your neck, deep pain near or over the shoulder blade, or pain that moves to the upper arm, forearm, or (rarely) fingers. You can also have numbness along your shoulder, elbow, forearm, and fingers.

The pain often starts slowly. It may get worse:

• After standing or sitting
• At night
• When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards

You may also have weakness in certain muscles. Sometimes, you may not notice it until your doctor examines you. In other cases, you will notice that you have a hard time lifting your leg or arm, standing on your toes on one side, squeezing tightly with one of your hands, or other problems. The pain, numbness, or weakness will often go away or improve a lot over a period of weeks to months.

Treatment of Disk Herniation

The first treatment for herniated disk is a short period of rest with medications for the pain, followed by herniated disk therapy. Most people who follow these disk herniation treatments will recover and return to their normal activities. A small number of people will need to have more disk herniation treatment, which may include steroid injections or surgery.
MEDICATIONS: People who have a sudden herniated disk in the back caused by injury (such as a car accident or lifting a very heavy object) will get nonsteroidal anti-inflammatory medications (NSAIDs) and narcotic painkillers if they have severe pain in the back and leg. If you have back spasms, you will usually receive muscle relaxants. Rarely, steroids may be given either by pill or directly into the blood through an IV. NSAIDs are used for long-term pain control, but narcotics may be given if the pain does not respond to anti-inflammatory drugs.
LIFESTYLE CHANGES: Diet and exercise are crucial to improving back pain in overweight patients.
Physical therapy is important for nearly everyone with disk disease. Therapists will tell you how to properly lift, dress, walk, and perform other activities. They will work on strengthening the muscles that help support the spine. You will also learn how to increase flexibility in your spine and legs.
You may want to reduce your activity for the first couple of days. Then, slowly restart your usual activities. Avoid heavy lifting or twisting your back for the first 6 weeks after the pain starts. After 2 to 3 weeks, gradually start exercising again.
INJECTIONS: Steroid injections into the back in the area of the herniated disk may help control pain for several months. These injections reduce swelling around the disk and relieve herniated disk pain. Spinal injections are usually done in your doctor's office, using x-ray or fluoroscopy to find the area where the injection is needed.
DISK SURGERY: Surgery may be an option for the few patients whose symptoms of a slipped disk do not go away with other treatments and time. Surgery many be suggested in severe cases of central disk herniation, vertebral disk herniation, cervical herniated disk, for bulge disk treatment etc.

Possible Complications

• Long-term back pain
• Loss of movement or feeling in the legs or feet
• Loss of bowel and bladder function
• Permanent spinal cord injury (very rare)

Authored By: Dr. S. V. Santpure