The spine is made up of a series of connected bones called “vertebrae.” The disc is a combination of strong connective tissues that hold one vertebra to the next, and acts as a cushion between the vertebrae.What is herniated disc?
The disc is made of a tough outer layer called the “annulus ﬁbrosus” and a gel-like center called the “nucleus pulposus.” As you get older, the center of the disc may start to loose water content, making the disc less effective as a cushion. This may cause a displacement of the disc’s center (called a herniated or ruptured disc) through a crack in the outer layer. Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist.
A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg called “sciatica.” Sciatica affects about 1-2% of all people, usually between the ages of 30 and 50. A herniated lumbar disc may also cause back pain, although back pain alone (without leg pain) can have many causes other than a herniated disc.What Treatments Are Available?
Most (80-90%) patients with an acute lumbar disc herniation will improve without surgery. Your health care provider will usually begin treatment with non surgical methods. If the pain still keeps you from your normal lifestyle after completing treatment, your health care provider might recommend surgery. Although surgery may not return leg strength to normal, it can stop your leg from getting weaker and help relieve leg pain. Surgery is usually recommended for relief of leg pain (greater than 90% success rate); surgery is less effective in relieving back pain.
Your health care provider may prescribe non surgical treatments including a short period of rest, anti-inflammatory medications to reduce the swelling, analgesic drugs to control the pain, physical therapy, exercise or epidural steroid injection therapy. The goals of non-surgical treatment are to reduce the irritation of the nerve and disc and to improve the physical condition of the patient to protect the spine and increase overall function. This can be accomplished in the majority of herniated disc patients with an organized care program that combines a number of treatment methods.Nonsurgical Treatment
Some of the ﬁrst treatments your health care provider may prescribe include therapies such as ultrasound, electric stimulation(IFT & TENS), hot packs, cold packs and manual (“hands on”) therapy to reduce your pain and muscle spasms, which will make it easier to start an exercise program. Traction may also provide limited pain relief for some patients. Occasionally, your doctor may ask you to wear a lumbar corset ( ﬂexible back brace) at the start of treatment to relieve your back pain, although it doesn’t help heal the herniated disc.Medication and Pain Management
Medications used to control pain are called analgesics. Most pain can be treated with non prescription medications such as aspirin, ibu-profen, naproxen, or acetaminophen. Sometimes, but not often, a doctor will prescribe muscle relaxants. If you have severe persistent pain, your doctor might prescribe narcotics for a short time. All medication should be taken only as directed. Non-steroidal anti-inflammatory drugs (NSAIDs) are pain relievers and are also used to reduce swelling and inflammation that occur as a result of disc herniation. Other medications are available that also have an anti-inflammatory effect. Corticosteroid medications—either oral or by injection— are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Epidural injections or “blocks” may be recommended if you have severe leg pain. Trigger point injections are injections of local anesthetics (sometimes combined with corticosteroids) directly into painful soft tissue or muscles along the spine or over the back of the pelvis.Surgical Treatment
The goal of surgery is to make the herniated disc stop pressing on and irritating the nerves, causing symptoms of pain and weakness. The most common procedure is called a “discectomy” or “partial discectomy,” in which part of the herniated disc is removed. In order to see the disc clearly, sometimes it is necessary to remove a small portion of the lamina, the bone behind the disc. Some surgeons use an endoscope or microscope in some cases.What Can I Expect After Surgery?
Most patients will not have complications after discectomy, but it is possible you may have some bleeding, infection, tears of the protective lining of the spinal nerve roots (dura mater) or injury to the nerve. It is also possible that the disc will rupture again and cause symptoms. This occurs in about 5% of patients. Ask your doctor for recommendations on post surgical activity restrictions. It is usually a good idea to get out of bed and walk around immediately after recovering from anesthesia. Most patients go home within 24 hours after surgery, often later the same day. Once home, you should avoid driving, prolonged sitting, excessive lifting and bending forward for the first four weeks. Some patients will benefit from a supervised rehabilitation program after surgery. You should ask your doctor if you can use exercise to strengthen your back to prevent recurrence.Do I Need Emergency Surgery?
Very rarely, a large disc herniation may press on the nerves which control the bladder and bowel , causing loss of bladder or bowel control. This is usually accompanied by numbness and tingling in the groin or genital area, and is one of the few indications that you need surgery immediately for a herniated lumbar disc. Call your doctor at once if this happens.