A herniated disc refers to a problem with one of the rubbery cushions (discs) between the individual bones (vertebrae) that stack up to make the spine.
The discs are protective shock-absorbing pads between the bones of the spine (vertebrae). The cushion-like discs between the vertebrae of the spine are also referred to as inter-vertebral discs. A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disc. Most people who have a herniated disc don’t need surgery to correct the problem.
Symptoms vary greatly depending on the position of the herniated disc and the size of the herniation. Most herniated discs occur in the lower back (lumbar spine), although they can also occur in the neck (cervical spine). The most common signs and symptoms of a herniated disc are:
1). Lumbar spine (lower back): Sciatica frequently results from a herniated disc in the lower back. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Along with leg pain, one may experience low back pain.
2). Cervical spine (neck): Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck.
A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
Certain individuals may be more vulnerable to disc problems and, as a result, may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families, with several members affected.
Risk Factors :
Factors that increase your risk of a herniated disc may include:
- Excess body weight causes extra stress on the discs in the lower back.
- People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase the risk of a herniated disc.
- Some people inherit a predisposition to developing a herniated disc.
Fortunately, the majority of herniated discs do not require surgery. However, a very small percentage of people with herniated, degenerated discs may experience symptomatic or severe and incapacitating low back pain, which significantly affects daily life.
The initial treatment for a herniated disc is usually conservative and nonsurgical. (A doctor may prescribe bed rest or advise the patient to maintain a low, painless activity level for a few days to several weeks. This helps the spinal nerve inflammation to decrease. Bed rest is not recommended)
A herniated disc frequently is treated with non steroidal anti-inflammatory medication if the pain is only mild to moderate. An epidural steroid injection may be performed utilizing a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation.
Physical therapy may be recommended. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises. Pain medication and muscle relaxants also may be beneficial in conjunction with physical therapy.
Surgery may be recommended if conservative treatment options, such as physical therapy and medications, do not reduce or end the pain altogether.
The benefits of surgery always should be weighed carefully against its risks. Although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help every individual.
A patient may be considered a candidate for spinal surgery if:
- Back and leg pain limits normal activity or impairs quality of life
- Progressive neurological deficits develop, such as leg weakness and/or numbness
- Loss of normal bowel and bladder functions
- Difficulty standing or walking
- Medication and physical therapy are ineffective
- The patient is in reasonably good health
Lumbar Spine Surgery :
Lumbar laminotomy is a procedure often utilized to relieve leg pain and sciatica caused by a herniated disc. It is performed through an incision down the center of the back over the area of the herniated disc. During this procedure, a portion of the lamina may be removed. Once the incision is made through the skin, the muscles are moved to the side so that the surgeon can see the back of the vertebrae. A small opening is made between the two vertebrae to gain access to the herniated disc. After the disc is removed through a discectomy, the spine may need to be stabilized. Spinal fusion often is performed in conjunction with a laminotomy. In more involved cases, a laminectomy may be performed.
In artificial disc surgery, an incision is made through the abdomen, and the affected disc is removed and replaced. Only a small percentage of patients are candidates for artificial disc surgery. The patient must have disc degeneration in only one disc, between L4 and L5, or L5 and S1 (the first sacral vertebra). The patient must have undergone at least six months of treatment, such as physical therapy, pain medication or wearing a back brace, without showing improvement. The patient must be in overall good health with no signs of infection, osteoporosis or arthritis. If there is degeneration affecting more than one disc or significant leg pain, the patient is not a candidate for this surgery.
Cervical Spine Surgery :
The medical decision to perform the operation from the front of the neck (anterior) or the back of the neck (posterior) is influenced by the exact location of the herniated disc, as well as the experience and preference of the surgeon. A portion of the lamina may be removed through a laminotomy, followed by a discectomy. After the disc is removed, the spine often needs to be stabilized. This is accomplished using a cervical plate and screws (instrumentation), and, often, spinal fusion.
Post-surgery specific instructions and usually pain medication will be prescribed. Some patients may benefit from supervised rehabilitation or physical therapy after surgery. Discomfort is expected during a gradually return to normal activity, but pain is a warning signal that the patient might need to slow down. Are you want to know more about Cervical Spine Surgery in India?