Disc Herniation Diagnosis and Treatment
Low back pain affects four out of five people, but pain alone is not enough to suspect a herniated disc. For the lumbar spine, the most common symptom of a herniated disc is sciatica, a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve. Other symptoms may include: weakness in one leg, tingling or numbness in one leg and/or the buttock, and loss of bladder or bowel control.
For the cervical spine, neck pain is common because pressure placed on a nerve in the neck causes pain in the muscles between your neck and shoulder. The pain may shoot down the shoulder and arm and may also cause headaches. Other possible symptoms include: weakness in one arm, tingling or numbness in one arm, and loss of bladder or bowel control. If you also have significant weakness in both arms or both legs, you could have a serious problem and should seek immediate attention.
When diagnosing a herniated disc, we will ask for your complete medical history and conduct a physical examination to help determine which nerve roots are affected (and how seriously). Other diagnostic tools may include: an x-ray to see if there is evidence of disc or degenerative spine changes; imaging tests, such as an MRI (magnetic resonance imaging) or CT (computed tomography), to confirm which discs are injured; and electromyography, a test that measures nerve impulses to the muscles.
Nonsurgical Treatment
Nonsurgical herniated disc and sciatica treatment is effective in treating the symptoms in more than 90% of patients. Most neck or back pain will resolve gradually with simple measures, such as rest and over-the-counter pain relievers, muscle relaxants, analgesics, and anti-inflammatory medications, as well as cold and hot compresses. Epidural injections and nerve root blocks are other options.
Surgical Treatment
In order to relieve intense pain and damaged nerves, surgery may be needed. A common herniated disc surgery technique is called a discectomy, which involves removing part or all of the damaged disc. This procedure can often be done utilizing minimally invasive surgical techniques, which involve smaller incisions and specialized technology such as microscopes and endoscopes (“mini-video cameras”). Microdiscectomy and minimally invasive techniques often result in quicker patient recovery times compared to traditional techniques, as they reduce trauma to muscles and minimize blood-loss during surgery. In addition to a discectomy, a portion of the bone covering the nerve may also need to be removed. This procedure is called a laminectomy.
If a spinal fusion is called for, the space left by the former disc may be filled with a bone graft or a bone substitute, which is used to join or fuse the vertebrae together. In some cases, specially designed instrumentation (such as rods or screws) may be used to help promote fusion and to add stability to the spine. Again, minimally invasive surgical techniques can be used, resulting in speedier recoveries, lower risk, reduced pain, and less damage to healthy tissue.
Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay. You should be able to return to work in 2 to 6 weeks after surgery.
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