Herniated Disc

Each intervertebral disc is composed of a sturdy fibrous outer wall called the annulus fibrosus.  The annulus encases and protects the nucleus pulposus, a thick gel-like center.  A disc herniation occurs when the annulus fibrosus is damaged and allows some of the nuclear material to ooze out and compresses nearby spinal nerve roots.  If the annulus tears near the spinal canal, the nucleus pulposus may push into the spinal canal.

The neck and low back (cervical and lumbar spine) are the most common levels where disc herniation occurs.  The neck holds the weight of the skull while being very mobile.  The low back supports a great amount of the body’s weight and absorbs and distributes stress.  While mid-back (thoracic spine) herniation is less common, this can be quite serious because there is little space surrounding the spinal cord at the thoracic levels (T1-T12).  Spinal cord compression can lead to paralysis.

Rarely does disc herniation occur in children.  A true herniated disc is most common in young and middle-aged adults – usually occurring in the low back.  Thoracic herniations are found to usually affect people between ages 40 and 60.

 

Causes of Disc Herniation

A disc may suddenly rupture if too much pressure is applied at one time.  Falling from a ladder into a seated position exerts tremendous force on the lumbar spine.  Bending forward, especially when lifting something heavy, may create forces that cause disc rupture.  Even small forces or repeated injuries add up over time and contributed to disc herniation.

 

Symptoms Attributed to Disc Herniation

An annular tear or nuclear rupture can compression the spinal cord and/or nerve roots.  There is also evidence that the damaged disc releases a chemical irritant that contributes to nerve inflammation and pain.  This chemical can lead to nerve dysfunction and cause pain that radiates (spreads), weakness, numbness, and tingling sensations from the injured area into the arms or legs.  The chart below features different symptom locations.

Cervical

Lumbar
  • Neck pain; not always severe
  • Pain, weakness, or numbness in the shoulders, arms, and legs
  • Burning sensations, tingling, and pins and needles in the involved extremity, such as the arm
  • Hand clumsiness
  • Gait and balance disturbances

 
  • Low back pain; not always severe
  • Pain, weakness, or numbness in the buttocks or legs
  • Burning, tingling, and pins and needles sensations
  • Difficulty and pain when walking, standing, or bending backwards. 
  • Pain  relieved by resting or leaning forward

In severe cases, a cervical and/or lumbar herniated disc may cause:

  • Bladder and/or bowel problems
  • Loss of function or paraplegia (rare)

 

Accurate Diagnosis Essential

An accurate diagnosis is essential to develop your treatment plan for a good outcome.  To begin, Doctor Frazier carefully analyzes your written medical history and opens up discussion by asking you many questions about your symptoms, when symptoms started, treatments tried, hereditary disorders, existing conditions, and lifestyle.

During the physical and neurological examinations, Dr. Frazier evaluates movement limitations, problems with balance, location of pain.  He reviews possible loss of arm or leg reflexes, muscle weakness, loss of feeling and/or abnormal sensations such as numbness or tingling.

Diagnostic tests may be necessary to reveal more information about your symptoms and to confirm your diagnosis.  To ensure the most accurate diagnosis, Dr. Frazier has access to a complete range of advanced diagnostic equipment including high-speed Magnetic Resonance Imaging (MRI), Computerized Tomography (CT scan), bone densitometry (DEXA), myelography, and discography.

 

Nonoperative Treatment of Disc Herniation

Nonsurgical interventions are usually the first step in the treatment of herniated disc.  Your treatment may include one or more therapies for maximum effectiveness.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Medication to relax muscle spasms
  • Pain medication
  • Physical therapy to increase flexibility, strength, and endurance
  • Injection therapies such as epidural steroid injections, trigger point injections, nerve root blocks, facet joint injections to relieve symptoms
  • Back and neck pain prevention, such as proper posture and biomechanics

If bowel or bladder dysfunction occurs or paralysis, surgical care may be immediately needed. 

 

When Spine Surgery May Be Recommended

A surgical recommendation may be made after nonsurgical treatments are exhausted, certain symptoms progress, and/or pain is unrelenting.  Of course, your individual treatment plan is adjusted to ease symptoms, restore and maintain function, and help you to lead an active and productive life.

If your cervical, thoracic or lumbar herniated disc requires surgery, be assured that Dr. Frazier will carefully and thoroughly explain:

  • Why he recommends spine surgery
  • How surgery may be of benefit
  • Possible risks and complications
  • When (how soon) is surgical treatment needed
  • Procedure name and type
  • How to prepare for surgery
  • Surgery aftercare and recovery

Dr. Frazier and his professional staff understand you have choices.  They have a deep commitment to patient education and want to help you make informed decisions about your health, medical care, and recovery.