FAQ’s on Lumbar Disc Herniation and Sciatica

June 13, 2012

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At every level of the spine from the skull all the way down to the sacrum, there is a spinal disc. The medical term is intervertebral disc, and it consists of 80% water in the normal individual. These discs act as shock absorbers, permitting the incredible range of motion that humans have with their spines. As a person moves, the disks absorb the stresses and water is pushed out of the disc. Water comes back into the disk subsequently and the height is restored.

With age, the intervertebral disc starts to lose some of its water. It can degenerate and lose height permanently along with developing some tears in the outer portion of the disk.

How does a lumbar disc herniation occur?

The best analogy for a disc herniation involves a jelly donuts. The inner part of the disc is similar to the inner part of the doughnut, and is like the jelly. The outer part of the disc is similar to that of a doughnut, it is a covering that asked to contain the jelly. When the desk degenerates, a tear can occur in the outer portion leading to extrusion of some of the inner gelatinous material.

This may be due to trauma, or an accumulation of degeneration that let up to a tear. The amount of disc material that extrudes from inside will be variable along with whether or not it completely separates from the disk completely or it stays partly attached.

How common is a lumbar disc herniation?

Research has shown that at any one point in time, approximately 1% of America is suffering from a herniated disc. That amounts to over 3 million people. Over 90% of disc herniation’s occur at the bottom two levels of the lumbar spine which are the L4 – L5 level for the L5 – S one level. It is unclear why so many disc herniation’s occur at these two levels but the presumption is that is where most of the spinal motion occurs in the lower spine.

What are the symptoms of a herniated disc?

Some people who have a disc herniation do not have any symptoms. Just because there’s a tear in the disk and material extrudes, does not mean it is going to hurt. There are some nerve endings in the outer part of the human disc, so it can be painful when that occurs. If the extruded disk material pushes on a nearby nerve root, that can spark up some pain.

A compressed nerve often develops inflammation around it. This can cause pain to radiate down that nerve root, and this is called sciatica. This can lead to a burning, searing pain that can go all the way down to the foot depending on which nerve root is involved.

A person may experience numbness or pins and needles in addition to the pain. It is variable as to what symptoms will be experienced. The symptoms are usually positional, if a person lays in bed with their knees bent the symptoms are often much more tolerable than when one is standing up and walking.

How is a herniated disc diagnosed?

When a patient is having symptoms of a disc herniation, history and physical examination are key to helping make the diagnosis. In fact, often times the exact level of disc herniation can be identified based on where the patient is having pain and what is seen on the physical examination tests.

Plain x-rays are not helpful at all in making the diagnosis. The best imaging study is an MRI which can show at which level the disk herniation is occurring and how large it is. The MRI can also show Herniated Disc on MRI whether the disk herniation is in the typical format called a poster wrote lateral herniation, or in an unusual format called a far lateral disc herniation. The treatment for each is slightly different.

What are the treatments available for a symptomatic disc herniation?

When an individual is dealing with a pinched nerve that is causing symptoms from a disc herniation, there are several nonsurgical options available for pain relief.

1. For initial treatment, Pain medication may help dramatically. This may include non-narcotic options such as nonsteroidal anti-inflammatories or Tylenol. It may be necessary to have narcotic medications along with this on a short-term basis.

2. Along with the pain medication, muscle relaxants such as Valium and Skelaxin may help as well. There are also neurologic modifying agents such as gabapentin which can help mitigate the pain as well.

3. Physical therapy and or chiropractic treatment-this may help a lot with pain relief, or it may be needed to have an epidural steroid injection first with pain management doctors in Florida to be able to participate in the therapy. Additional treatments with the specialist may include a TENS unit along with electrical stimulation treatment.

4. Spinal Decompression Therapy-this is an FDA cleared revolutionary treatment that has been shown to be over 85% effective in the treatment of symptomatic disc herniation’s. It can help tremendously along with the other options offered at comprehensive pain centers.

5. Epidural Steroid Injections – cortisone injections have been used for over 50 years for the treatment of symptomatic lumbar disc herniations. Multiple research studies have shown their effectiveness to be over 75% good to excellent for pain relief. The injection itself does not fix the problem, rather it can provide a Band-Aid of pain relief for weeks to months. A series of three injections at a pain clinic such as pain management Orlando may be necessary over a period of six weeks or so to achieve optimal results.

When is surgery necessary for a herniated disc?

There are absolute, relative and elective indications for surgery for a disc herniation. Surgery is absolutely necessary if the person is experiencing a rare condition called cauda equina syndrome. This is due to a large compression on the area at the bottom of the spinal cord, and may lead to loss of bowel and bladder function. This can be permanent if not treated within 24 hours. So surgery for this is absolutely necessary.

Foot Drop

Often times, surgery is done as an elective quality-of-life decision. If pain relief is not achieved with nonoperative measures for over 6 to 8 weeks at a clinic such as a pain clinic in Palm Beach County, then a lumbar discectomy can be performed as an elective procedure for pain relief.

What is the success rate for nonsurgical treatment of a lumbar disc herniation?

Over 95% of lumbar disc herniations can be treated nonoperatively. This is great because even though the risks of lumbar disc surgery are small, they are real. Therefore any time you can treat a disc herniation effectively without a surgical procedure it is optimal.

A landmark study a few years ago published in the Journal of the American Medical Association showed that surgical treatment of the lumbar discrimination is better initially, but after that you’re to the results are identical.

If you live in Florida and are suffering from a herniated disc with sciatica, call a Florida pain clinic in the Florida Pain Network today. There are pain doctors in the Network who are Board Certified and can help you tremendously. You can visit the page here to put your zip code in or call (877) 877 8556 for help.

What Exactly is a Disc Herniation with Sciatica?

April 13, 2012

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At any one point in time, approximately 1% of America is suffering from a pinched nerve as a result of a disc herniation in the lumbar spine. This is known as sciatica and can create disabling pain for patients for a long time.

What exactly is a disc herniation? At every level of the spine there is a shock absorbing soft tissue that exists between the bony areas. This is called the intervertebral disc.

Intervertebral Disc

In a normal disk, it is composed of 80% water and 20% collagen and other proteins. The discs are the reason that humans enjoy such an incredible range of motion of the spine.

There are two types for areas in the disc, the inner part is called the nucleus pulposus and the outer part is called the annulus fibrosis. The nucleus actually has no nerve endings and is not a source of pain for patients. The analogy that best describes it is that of a jelly donut. The inner nucleus part is analogous to the jelly of the doughnut and the outer annulus part is analogous to the donuts covering.

When a person has pain from a disc herniation the first thing that happens is the individual has a tear in the annulus, which is the outer part of the desk. There are a lot of individuals in America who have degeneration of their disks with no pain, the figure is that 40% of individuals over the age of 40 have this degeneration and no back pain at all. As people age, water slowly seeps out of the disk and degenerate, with the analogy being that humans start to turn into prunes as they age.

As degeneration occurs, the annulus is likely to develop tears in it and this can create pain as there are nerve endings in this area of the disk. This my necessitate an epidural injection from a pain management Jacksonville doctor.

A tear in and of itself may cause back pain, and if the tear is big enough part of the inner jelly from the nucleus can squeeze out and create a herniated disc. If this touches on a nerve root, it can create inflammation and pain that radiates down the leg, this is called sciatica.

Disc Herniation

As long as the disk material is pushing on the nerve root, the patient may have a lot of pain. The body knows that that piece of disc is not in the right place, so over time it will typically disintegrate that portion. This is why studies have shown that if people can avoid an operation for a disc herniation, the results of nonoperative treatment will usually be no different than at the one year timeframe. So if a person can receive physical therapy, pain medications, epidural injections, those can help up patient avoid surgery, relieve pain and not have those risks.

The Florida Pain Network offers listing of pain management clinics in Florida, chiropractors, and physical therapy practices throughout the state. The listings are geographically targeted, showing those closest to you.

For example, if you need pain management Miami, click on Miami under the pain management tab and simply input your zip code. Options pop right up. Or call (877) 877-8556 today.

When Should a Spinal Fusion be Added to a Lumbar Discectomy?

February 11, 2012

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The most common spine surgery in the US is a lumbar discectomy procedure. It is a surgery that is done hundreds of time a day in America, and the risks are fairly low compared with major spine surgeries.

The surgery itself takes about an hour and patients either go home the same day or often times the next day. At what point would a surgeon consider adding a spinal fusion to that level as opposed to just doing a discectomy? This addition to the surgery adds risk to the procedure along with increased blood loss and potential for further surgery in the future. But there are indications for adding it to the procedure. Pain Management Boca Raton

The 1st reason for adding the procedure is if there have been multiple discectomies done at that level. Every time a lumbar discectomy is performed the surgeon takes out a piece of the disk at that level. The disc does not then go and regenerate the removed tissue. It undergoes a degenerative process which can cause severe back pain in those patients. Each subsequent time a surgeon does a discectomy procedure, more disk is removed and the chances for degenerative disc disease with severe pain go up considerably.

The chances of a recurrent disc herniation at the same level are about 10%. So it does happen a significant part of the time, and if it does the patient needs to be asked how much back pain are they having? The reason is that if the disk pinches a nerve it may cause significant sciatica and leg pain. But often times patients do not have any back pain.

So if there is a considerable amount of back pain present and this is not the first disc herniation at that particular level, then it may be that the patient has significant degenerative this disease and while removing the piece of disk pinching a nerve, consideration should be given to fusing that level. That can address the leg pain with the discectomy and then the back pain by fusing that