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Herniated Disc


Herniated disc is a medical condition affecting the spine in which the inner central portion (nucleus pulposus) of the spinal disc is forced outthrough a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc. Herniated disc is also known as a bulging disc, ruptured disc or slipped disc.

A herniated disc may result from a wear and tear of the disc due to aging. As you age the spinal discs dry out and become less flexible and are more susceptible to tear or rupture.

Herniated disc may also be caused by injury to spine. When injury occurs, the central core of the disc is pushed through a tear in the outer hard layer of the disc, causing a bulge and pressing on nearby nerves. If the herniated disc presses on a spinal nerve, it can cause back pain.

Four degrees of disc herniation include nuclear herniation, disc protrusion, nuclear extrusion and sequestered nucleus.

The most common signs and symptoms of a herniated disk are:

  • Disc herniation in the lower back causes back pain that radiates to buttocks and legs
  • Disc herniation in the upper back causes neck pain that radiates to the shoulders and upper arms
  • Numbness or tingling
  • Muscle weakness

Diagnosis

Your doctor can make the diagnosis of a herniated disc by asking questions about your symptoms and by performing a physical examination that tests sensation, muscle strength, and reflexes. The straight leg raise test is positive if pain is evoked when the straight leg is raised when lying or sitting. Other imaging tests such as X-rays, an MRI or a CT scan may be ordered to confirm a herniated disc. Plain X-rays of the spine may help detect wear and tear of the spine. A CT scan provides better visualization of the anatomy of the intervertebral discs and spinal cord.

An electromyogram, a test to detect abnormal electrical activity of muscle, can be used to help pinpoint the location of the nerve damage.

Treatment

Most often, the vast majority of patients with a herniated disc respond to conservative therapy such as medication, rest and physical therapy.

Medications: Medications such asnon-steroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, to reduce the inflammation and to relieve pressure around the compressed nerves. Oral steroid medications may be used in episodes of an acute (sudden) disc herniation. Other medications such as muscle relaxant medications and pain medications may be prescribed. Your doctor may also recommend epidural steroid injections which are directly injected into the area of nerve compression to relieve the compression on the nerves.

Rest: Avoid activities that may worsen your symptoms.

Physical therapy: Your doctor or physical therapist may suggest some exercises to keep the back muscles strong and help protect against future injury.

Surgery may be considered only after conservative therapy fails to adequately relieve the symptoms over a substantial period of time. Microdiscectomy using small surgical instruments and open surgical repair (either from a posterior or anterior approach) may be performed to remove the protruding portion of the disc. In some cases spinal fusion may be performed to provide stability to the spine.

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Herniated Disc of the lower back

Herniated disc is a condition in which the outer fibers (annulus) of the intervertebral disc are damaged causing the soft inner material of the nucleus pulposus to rupture out of its space. A herniated disc, common in the lower back (lumbar spine) occurs when there is a tear in the outer lining of the disc (annulus fibrosus).This causes the inner jelly-like material (nucleus pulposus) to leak out and place pressure on the adjacent spinal nerve root. It is the most common cause of low back pain and pain that radiates down the leg (radiculopathy).

The most common signs and symptoms of lumbar disk herniations are back pain that radiates to buttocks and legs, numbness in the leg or foot, weakness in the leg or foot, and rarely loss of bowel and bladder control.

Diagnosis

Proper diagnosis of the condition requires a complete medical history and a careful physical examination by your physician. Some of the additional diagnostic tests your doctor may suggest include:

  • X-ray of the middle-back: X-rays help to detect the amount of wear and tear present and to rule out other conditions.
  • CT and MRI scan: These tests are done to confirm the diagnosis of herniated disc.

Treatment Options

Conservative Treatment

Conservative treatment includes pain medications, physical therapy, and avoiding strenuous activity if the pain is severe.

Epidural Steroid Injection (ESI): ESI can be considered if the pain is intolerable even with medications and rest.

Surgical Treatment

Lumbar microdiscectomy is a surgical procedure done to remove a herniated part of the disk and any fragments that are putting pressure on the spinal nerve. This surgical procedure involves use of a surgical microscope and microsurgical techniques to gain access to the lumbar spine. The microscope magnifies and illuminates the area of operation. Only a small portion of the herniated disc that pinches on the nerve roots is removed.

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