Disc Herniations

By Edward S. Pratt, M.D., M.B.A.

These injuries occur when the outer ring of the disc (annulus) weakens and tears, allowing the soft inner material within the disc (nucleus) to pass out of the confines of the disc and into the spinal canal. Most commonly this injury occurs in a disc which has begun to have some degree of degeneration, yet have relatively young fluid nuclear material that is still mobile. Disc herniations most commonly occur during the 30s and 40s, but can occur at any age. Although some disc herniations can probably be avoided through proper warm up and lifting technique, they occur in many patients without any manageable risk factors identified.

The nuclear material compresses nerve roots or spinal cord, and incites an inflammatory response that can further cause pain. The pain experienced most commonly is a combination of leg or arm pain, tingling and numbness with about half of patients suffering pain in the back, neck or between the shoulder blades as well. The treatment of disc herniations should always be conservative at first, unless there are clear signs of progressive weakness, numbness or loss of bowel and bladder function. Nearly 70% of these injuries will gradually subside with non surgical treatment. This treatment should include a short period of rest, anti-inflammatory medications, gentle stretching to maintain range of motion, and if possible increase the space available for the compressed nerve root. Avoiding activities that aggravate the arm or leg is also important. Nearly 50% will improve over four weeks with this treatment alone. Those that do not are usually offered a targeted epidural steroid injection, done under direct fluoroscopic vision. If pain persists outpatient microscopic discectomy in the low back, or discectomy with anterior fusion in the neck is the treatment of choice. It is important to point out that any surgical treatment is never an endpoint in and of itself. The success of any procedure depends upon the quality of the post surgical rehabilitation one receives and how closely one follows his or her surgeon’s post surgical plan.