Lumbar Disc Herniation
Our spine and disc take a lot of stress over time. Most herniated disc’ are a result of a trauma or an accident putting direct stress on the disc. Gradually over weeks or months the outer annulus develops cracks and the inner gel-like nucleus is pushed out to become a bulging disc. When this occurs the disc puts pressure on the spinal cord (dura) and or nerve roots that branch our at each level and travel down your legs connecting to your muscles. A bulging disc is not always symptomatic. However, when the annulus becomes brittle and tears that bulging nucleus can protrude (ruptured disc) and extrude (herniated disc) or leave the disc entirely called sequestered disc. With time that herniated disc can become more pronounced and put significant pressure on the spinal nerves. This pressure and nucleus fluid that leaks out causes inflammation and pain sometimes localized to the back, buttock, thighs and sometimes all the way down into your calves and feet.
One of the most common causes of low back and leg pain is a lumbar herniated disc. Lumbar discs are made up of a tough interwoven like fabric called the annulus fibrosus and an inner cotton/get-like center called the nucleus pulposus. The discs are located between each vertebrae and serve a role as a shock absorber.
Causes of Herniated disc
Our spine and disc take a lot of stress over time. Most herniated disc’ are a result of a trauma or an accident putting direct stress on the disc. Gradually over weeks or months the outer annulus develops cracks and the inner gel-like nucleus is pushed out of the disc. When this occurs the herniated disc puts pressure on the spinal cord (dura) and or nerve roots that branch our at each level and travel down your legs connecting to your muscles. This pressure and nucleus fluid that leaks out causes inflammation and pain sometimes localized to the back, buttock, thighs and sometimes all the way down into your calves and feet.
The following risk factors can contribute to herniated disc:
- Aging: As we age our discs gradually dry out losing its strength and structural integrity.
- Lifestyle: Not maintaining a well balanced diet, lack of regular exercise, over weight and smoking contribute to poor disc health
- Posture: Poor mechanics when lifting or twisting puts additional stress on the spine and disc.
If pain still persists and patient is intolerant to the pain after non-surgical treatment and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended. The following surgical options can treat herniated disc with 90% success:
- Sharp or dull pain in the lower back which gets worse with physical activity such as lifting, bending, or as simple as coughing or sneezing, muscle spasms or cramping.
- Sciatica (pain, burning, tingling, and numbness that extends from the buttock into the leg or foot).
- Leg weakness or loss of leg function.
Accurate and thorough diagnosis is key to selecting the best treatment options.
The following is part of a comprehensive diagnostic workup:
- Medical history. Assessment of symptoms, previous treatments and care.
- Physical examination. A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic tests. Generally, we start with plain x-ray films, which allow us to rule out other problems such as infections. CT scans and MRIs are often used to give us three-dimensional views of the lumbar spine and can help detect herniated discs.
Most cases of lumbar disc herniation do not require surgery. Research evidence suggests that pain associated with a herniated disc often diminishes without surgical treatment within 4-6 months. Thus, patients are usually prescribed non-surgical treatments initially to help relieve symptoms.
- Pain medications: anti-inflammatories, muscle relaxers and on rare occasions narcotic painkillers
- Alternating heat/cold therapy during the first 24-48 hours
- Physical therapy exercises to include: stretching, massage strengthening
- Epidural steroid injections are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.
If pain still persists and patient is intolerant to the pain after non-surgical treatment and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended.
The following surgical options can treat herniated disc with 90% success:
- Microdiscectomy: Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loops that helps magnify the anatomy. Recovery can be long and painful. Most of the pain post-operative is from the approach the surgeon made through major muscle support in your back. Anesthesia is necessary.
- Laminectomy: During the microdiscectomy surgeons often have to resect the bone called the lamina in order to see the affected nerve and herniated disc. Recovery from microdiscectomy can be long and with bone resection adds to possible scarring in the area the surgeon is working. Anesthesia is necessary.
- Endoscopic Discectomy (transforaminal or interlaminer): With an incision less than a ½ inch. The surgeon can avoid all lamina bone resection and enter the spinal canal without disturbing or cutting muscle. The surgeon directly observes the herniated disc in a water (arthroscopy) environment with a surgical working channel endoscope coupled with a HD camera. Recovery is superior to microdiscectomy with most patients returning to work within a week. Conscious sedation is used with the patient awake, comfortable and aware during the procedure.
Spine fusion should always be a last resort scenario for patients with discogenic back pain and a herniated disc. Our endoscopic discectomy techniques allow our physicians to pinpoint the herniated disc and with patients under conscious sedations instead of general anesthesia making the smallest incision in spine surgery. Endoscopic discectomy uses a ¼ inch incision, placing a 7mm working cannula from the patient’s side directly through the foramen avoiding all major muscle and tissue destruction and the use for a laminectomy. With a working channel endoscope and an HD camera the physician is able to better visualize and decompress the herniated disc and the affected nerve.
At our practice, most patients can begin getting out of bed one hour after surgery and go home shortly afterwards. Activity is gradually increased and patients are typically able to return to work within a few days. There will probably be some pain after the procedure and is usually localized to the incision site. However, we want you to be as comfortable possible and will provide you adequate pain medications.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. We will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. We will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.
The Jasper Spine Institute Interventional Pain Management Advantage:
- Less than ¼ inch incision
- Less post-operative pain and recovery than traditional minimally invasive procedures
- Outpatient procedure with patients discharged within 2 hours of surgery
- Return to work within 3-5 days*
At Jasper Spine Institute we listen and work with you to develop a unique treatment regime that addresses your pain and symptoms. Our goal is always to provide solutions whether conservative or surgical so that you are able to return to the quality of life you want without the pain and suffering.
* Always seek your physician’s opinion when it is safe to return to work. Also, light administrative duty is recommended until your physician approves of any physical demands at your place of work.