Disc Herniations

What is a herniated disc?

A small portion of the disc which protrudes out of the annulus of the spinal canal indicates a herniated disc. Each disc, located between two vertebral bodies – the strong outer ligamentous ring called the annulus fibrosus and an inner jelly-like section called the nucleus pulposus. The annulus fibrosus and nucleus pulposus work together to evenly distribute pressure across the disc.Some patients may also refer to this condition as a bulged, slipped or ruptured disc. Once the herniated disc presses into the spinal canal through a tear or rupture in the annulus, the disc usually begins an early stage of degeneration, causing pain or irritation to the nerve.

In many cases, a herniated disc may resolve over time thru self-care and time. For most people who develop back pain — whether it is because of a herniated disk or due to another problem — symptoms often go away within six to eight weeks.

An untreated, severe slipped disc can lead to permanent nerve damage. In very rare cases, a slipped disc can cut off nerve impulses to the cauda equina nerves in your lower back and legs. If this occurs, you may lose bowel or bladder control.

How common are herniated discs?

The highest prevalence of herniated or ruptured discs exist among patients between 30-50 years, with a males experiencing this condition almost double that of females. In patients between 25-55 years, about 95% of herniated discs exist at the lower lumbar spine (L4/5 and L5/S1 level). Only in patients over 55, is more common above the lumbar level. Sciatica is one of the most common forms of herniated disc pain.

How are herniated discs treated?

Lumbar herniated disc treatments typically begin with nonoperative therapies and progress depending on the response of the patient to the treatment. The good news is that remedial massage can be very beneficial in treating bulging or herniated disc symptoms. In some cases this can result in a decrease in pain and muscle spasms; increased range of motion of the joints. Unfortunately, if this modality does not help manage the patient’s pain levels, the physician may opt for other treatments such as:

• Physical therapy, exercise and gentle stretching can alleviate pressure on the nerve root and mitigate symptoms.
• Ice and heat therapy may be utilized to relieve pain and reduce inflammation.
• Manipulation (such as chiropractic manipulation)
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or COX-2 inhibitors for pain relief

What does disc herniation surgery look like?

Surgery should relieve pressure off the nerves bothered by the herniated disk. The two most common surgeries include:Discectomy

During this surgery, the surgeon removes the damaged disk to relieve pressure off of the impinged or inflammed nerves. The surgeon can perform this in a couple of ways:

• An open discectomy performed thru an incision in the back or neck.
• Performed thru a much smaller incision, in a Microdiscectomy the surgeon inserts a thin tube with a camera on one end to see the damaged disc to remove the necessary tissue.

Lumbar Laminotomy

On occasion, the surgeon will also need to remove the lamina (a small piece of bone) from the vertebra. The lamina is the thin layer which forms a cover to protect the spinal cord. Thru the partial or whole dissection, the surgeon gains easier access to the herniated disk. It also can relieve pressure on your nerves and stop leg pain and sciatica. A Laminotomy removes some of the lamina. A Laminectomy removes most or all of the lamina.