One of the most common problems seen by pain management clinics is a person experiencing pain from an intervertebral disc herniation. Here are some commonly asked questions regarding disc herniations.
What are other names for a disc herniation?
Additional terms for a disc herniation include slipped disc, pinched nerve, lumbar disc herniation if it’s in the low back, ruptured disc, or cervical disc herniation if it occurs in the neck.
How common are disc herniations?
It’s a very common problem. At any one point in time, one percent of the population is experiencing sciatica from a disc herniation. Sciatica occurs when a disc herniation actually pushes on a nearby nerve root, creating inflammation and pain in that nerve root that goes down a person’s leg.
So one percent of the American population is over 3 million individals. There are an additional amount of people who have a disc herniation but are not experiencing sciatica. If the disc herniates and does not push on a nearby nerve root, sciatica may not result.
An individual may have back pain but not leg pain, so essentially there may be another 1% of people experiencing issues with a disc herniation and not sciatica, so the overall amount is between one and 2%.
How does a disc herniation occur?
The healthy intervertebral disc is composed of 80% water and the remaining 20% is a combination of collagen and proteins known as proteoglycans. The disc acts as a great shock absorber and allows significant range of motion when it is healthy. Due to advancing age, trauma or for genetics, the person may experience degeneration of the disc and loss of water content.
The disc itself is best analogous to a jelly donut. The inner jelly is called the nucleus pulposus and the covering to the donut is called the annulus fibrosis. The annulus is the only part of the disc that experiences pain because it does have some nerve endings there. Due to disc degeneration, the annulus can experience a tear which can lead to back pain along with some of the inner jelly squeezing out.
This is known as a disc herniation. If the jelly that squeezes out then compresses on an adjacent nerve root, that is called in layman’s terms a pinched nerve. This can then spark up inflammation and sciatica consisting of a burning, electrical type pain down the leg, numbness and possibly muscle weakness.
What are the symptoms of a disc herniation?
It is possible to have a disc herniation and have no pain whatsoever. A significant amount of the American population has disc degeneration and no back pain whatsoever. If a person has a tear in a disk and some of the disc squeezes out, the pain that is experienced is due to an inflammatory reaction. So if that inflammatory reaction does not occur, pain will not typically ensue.
If it does, symptoms may consist of just back pain, or a person may have no back pain at all but simply sciatica. Back pain usually spreads out to one or both sides of the low back, an individual may also have substantial muscle spasms as a protective effect. The pain may also radiate into the buttock area or around to the hip or groin.
Sciatica pain usually feels like a burning or electrical type sensation along with some numbness or pins and needles. The area of the pain typically correlates with whichever nerve root is being pinched.
It may go down the back of the thigh into the foot, or on the front of the thigh, or on the front of the shin. The pain is not usually constant, it will vary with positioning and then come and go depending on the time of the day.
How is a herniated disc diagnosed?
In most cases, there is an established method for making the diagnosis. Usually a person’s history will raise suspicion for a herniated disc. If the person walks right out of a textbook, he or she will describe pain that goes down the leg in a pattern that correlates with a nerve root.
There are some specific physical examination signs that can tip off the doctor including a straight leg raise test if it is positive for tension signs.
X-rays are not helpful in the diagnosis of a herniated disc, it is an MRI that typically will show the disk herniation nicely and how large it is. There’s not a great correlation between the size of the disk herniation and the amount of symptoms experienced. It may be a very small disc herniation, yet produce very big symptoms.
What are my treatment options with a herniated disc?
Most of the time, treatment options for a herniated disc to come a quality of life elective decision. Only if it leads to significant neurologic symptoms should surgery be considered either emergently or as a relative indication.
Without motor weakness or bowel or bladder symptoms it truly is a quality-of-life decision. If the person is experiencing mild to moderate pain, then anti-inflammatory medications, Tylenol and maybe some ice and heat might suffice.
For more significant symptoms, the person may need physical therapy, chiropractic treatment, or maybe spinal decompression therapy as well.
A TENS unit may help, which is a device about the size of an iPod that can be placed on the belt and be very mobile. You can help tire out the muscles around the back and relieve muscle spasms and also help change the way the brain perceives pain signals.
Treatment with a pain management doctor may consist of medication management along with interventional treatment. This may consist of short-term narcotics along with some muscle relaxers. With regards to interventional treatments, the gold standard is there are multiple different ways of performing the injections, and a series of 1 to 3 procedures may be necessary depending on how well they work. Injections usually work over 75 to 80% of the time for significant pain relief.
If substantial conservative treatment for over six weeks is ineffective, then surgery should be considered. If neurological deterioration occurs before then, then surgery should be considered sooner but it is best to make that decision in conjunction with your doctor.
What are my chances of needing surgery?
The vast majority of those experiencing sciatica symptoms will not end up needing surgery Over 95% of those with sciatica symptoms are able to achieve adequate pain relief with the above mentioned treatments. This is really good news considering there are some small but real risks associated with herniated disc surgery.
The Florida Pain Network connects those in pain with pain relievers around the state. This includes pain clinics in south Florida, pain management Orlando clinics, Tampa pain management and more. The pain doctors are Board Certified and offer comprehensive treatments including medication management and injections. Chiropractors offer manipulations, physical rehabilitation and spinal decompression therapy.
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