A disc herniation is a condition affecting the intervertebral discs of the spine. Intervertebral discs are the soft, spongy discs between the bones of the spine (vertebrae) that serve to cushion the spine and space the vertebrae apart while allowing the full range of motion that the spine has. These discs may become injured, or due to natural degeneration, become herniated.
When a disc is herniated a tear on the rigid outer wall of the disc (the anulus fibrosis) allows a part of the gel-like center (the nucleus pulposis) of the disc to protrude through. This protrusion often makes contact with a nerve root (this is called an impinged or compressed nerve) or the spinal cord itself and causes a great deal of pain as well as other issues related to the nerve.
A herniated disc can be caused by trauma (injury) or by natural age related degeneration of the spine. About 75% of people will experience some form of back pain during their life. Persons most susceptible to a disc herniation are the elderly, the overweight, and those with strenuous jobs like construction workers.
What are the symptoms of a herniated disc?
Symptoms of a herniated disc are area specific dependent upon what nerve is being affected although they are the same no matter what part of the body is affected. These symptoms include pain, numbness or tingling of an extremity or other area of the body.
For example, a cervical (the neck) disc herniation can cause symptoms to appear in the shoulder or arm and even into the hands, while a lumbar (lower back) disc herniation may cause symptoms in the buttock, leg, and foot. Other symptoms include weakness and loss of dexterity in the area of the body affected by the specific nerve affected.
Symptoms of a lumbar disc herniation affecting the nerves of the cauda equina (a bundle of nerves exiting the spinal column) can cause the person to experience loss of bladder and bowel control as well as pain and numbness in the lower extremities. In rare extreme cases when the cauda equine is affected paralysis may occur.
How is a herniated disc diagnosed?
Diagnosis for a herniated disc involves a physical exam where the doctor may test your reflexes, muscle strength and your ability to walk and feel light sensations like a pinprick or a tickle.
If a herniated disc is then suspected the doctor will have you undergo imaging like MRI (magnetic resonance imaging), a CT scan (computerized tomography), or a myelogram. This is where dye is used by injecting it into the spinal fluid and then utilizing x-ray to locate areas where a herniated disc exerts pressure on a nerve.
What are the available treatments for a herniated disc?
The use of NSAID’s (non-steroidal anti-inflammatory drugs), non-narcotic analgesics, or prescription anti-inflammatories and narcotic analgesics may be used to treat the pain associated with a herniated disc. If these treatments prove ineffective a nerve block injection may be used. A nerve block injection used a mixture of local anesthetics and corticosteroids to numb the nerve to stop pain signals to the brain.
What are expectations when a patient gets treatment?
A patient has a reasonable expectation to experience relief from pain and other symptoms from one, or a combination of these treatments. The nerve block injection has proven to be very effective for most patients in relieving their symptoms.
How is the procedure/treatment performed?
A nerve block is performed as an outpatient procedure and usually only takes about a half hour to perform followed by a half hour observation period to watch for negative reactions to the drugs used. The patient is placed on an exam table and the skin of the area(s) to be injected are cleansed with antiseptic solution then numbed with topical anesthetic. Then with the aid of a fluoroscope (a type of xray
machine) to ensure proper needle placement, the mixture of medications are slowly injected. Often immediate relief will be experienced due to the local anesthetic, this wears off after about 24 hours and the steroid medications will take effect after 24-48 hours.
How long do the treatment/injections last?
The effects of the steroid medications can last anywhere from several days to several weeks after the first treatment. Repeated treatments often prolong relief for several months at a time.
What risk or side effects are there?
Risks and side effects are minimal and may include light bruising and bleeding at the injection site.
How successful are they for the relief of pain?
The majority of patients receiving these injections experience some relief from their pain and other symptoms, often for months at a time. Discuss with your doctor to see if these injections could help you.