Disc Herniation

There are many terms used for a Disc Herniation. Some include herniated nucleus pulposus, ruptured disc, blown out disc, and slipped disc. To understand what it is and how it can be treated you have to understand what a disc does and how it is designed.

The disc is the natural shock absorber in your spine. It sits between the bones of your spine and provides cushioning, as well as connecting one bone to the other. The disc is constructed like a tire, with a hard, rubbery layer around the outside called the annulus. The inside is filled with a gelatin-like material called the nucleus.

When a disc herniates, the outer covering of the disc, the annulus, breaks. The material inside then squirts out. Your body responds to this as back and leg pain. Sometimes, if the pressure on the nerve is great enough, there can be loss of nerve function causing numbness, weakness, and loss of reflexes. In the worst cases, bowel and bladder function can be affected.

The body’s natural response to a disc herniation is to dry out the disc. As the disc dries it shrinks, causing less pressure on the nerves.

What Treatments Exist?

There are several treatments for Disc Herniation:

Exercise: Exercise which strengthens your back and stomach muscles, done along with instruction on posture and movement, has been shown to be very effective in the treatment of Disc Herniations. With good strength and proper body mechanics, you can decrease the amount of pressure the Disc Herniation is placing on the nerve. This can relieve pain and allow the body to begin drying out the disc.

Non-steroidal, Anti-inflammatory Medications: These medications (ie: Ibuprofen, Relafen, Lodine, Voltaren, Naprosyn, DayPro, etc.) can decrease pain and inflammation. Taken along with an exercise program, they can significantly relieve your pain. Patients may react differently to each of these medications. Often patients need to try several before the best one is found. Some new medications only need to be taken once or twice a day and are easier on your stomach.

Epidural Steroids: You may be given an injection of a steroid around the nerves, which are being squeezed. A steroid is the most powerful anti-inflammatory medication. Through this injection, a small amount of the most powerful medication is inserted exactly where your problem occurs. An x-ray machine is utilized to easily place the medication on the exact location. While this does not “cure” the problem, it can quickly calm it down, occasionally for many months. Often, when combined with a therapy program, this improvement can be nearly permanent. If needed, these injections can be repeated periodically.

Surgery: This is the last resort for a Disc Herniation and the only method to directly take the pressure off the nerve. The operation for a Disc Herniation can be done two basic ways: A Discectomy (a decompression) or a Laminectomy. In this operation, the surgeon makes a small incision in the back and removes the portion of the disc that is pressing on the nerve. The whole disc is not removed. Care needs to be taken not to injure the nerves or remove too much structural support from the spine. Hospitalization after surgery can last one to three days.

An exciting new procedure for Disc Herniation is called Arthroscopic Micro-Discectomy. In this procedure a small telescope, called an arthroscope, is inserted into the disc through a small cut. The piece of the disc pressing on the nerve is removed. Usually, no general anesthesia is needed, you can go home the same day, and all that is required is a small bandage. Unfortunately, only certain types of Disc Herniation can be treated with this procedure.