Herniated Discs

With time our discs naturally lose water (desiccate). Repetitive bending & twisting and/or trauma to the spine can cause shear stresses across the discs resulting in breakdown of the outer fibrous rings.  Gradually, the nucleus pulposus in the center of the disc can work its way through the outer fibrocartilaginous ring and compress nerves.  Technically, this is called a herniated nucleus pulposus. However, it is often called a ruptured disc, slipped disc, or herniated disc.

 

Disc herniations can occur between the second cervical vertebrae in the neck to the sacrum. Thoracic disc herniations only account for 1% of all herniations since there is little motion between the thoracic vertebrae due to the ribs. The most common levels to herniate in the neck are C5-6 & C6-7. The most common levels to herniate in the low back are L4-5 & L5-S1.

The symptoms of a pinched nerve (pain, numbness, tingling, burning, weakness, and/or loss of a reflex) are called a radiculopathy. The distribution of symptoms varies depending on which nerve root is involved. Some refer to a radiculpathy as “sciatica.” However, “sciatica” refers to pain along the distribution of the sciatic nerve. The sciatic nerve exits the pelvis and travels down the back of the leg. This nerve contains nerve fibers from the L4, L5, and S1 nerves. Technically, pain from a compressed nerve can only be considered “sciatica” if it involves one of these nerves. In other words, a pinched nerve in the neck causing arm pain is technically not considered “sciatica” since this wouldn’t involve the L4, L5, and/or S1 nerves.

 

Extremely large herniations in the neck and thoracic spine can compress your spinal cord leading to balance difficulties, problems using your hands, and even paralysis of your arms and legs. This is called “myelopathy,” and can be considered a medical emergency. A large disc herniation in the low back that causes severe compression of the nerves in the spinal canal can lead to “cauda equina syndrome.” This is also a medical emergency and can cause severe numbness in your groin (saddle anesthesia), bowel and bladder incontinence, as well as pain and numbness in the legs. If you experience the above symptoms, you should seek medical attention immediately.

The diagnosis is first suspected when a patient complains of pain, numbness, tingling, burning, and/or weakness radiating from their neck down their arm(s) or from their low back down their leg(s). Thoracic disc herniations can also cause radicular symptoms (pain, numbness/tingling, weakness and/or burning) across your chest. After a detailed examination, the diagnosis can be initially evaluated with plain X-rays and confirmed with an MRI of the spine.

Luckily, over 90% of disc herniations do NOT require surgery because they are eventually absorbed by the body. Time is the most effective treatment. However, symptoms can be controlled with pain management, physical therapy, and activity modifications. For patients with more severe or persistent symptoms, they may benefit from an epidural spinal injection. Patients with severe pain and those who do not achieve long lasting pain relief from injections, may be candidates for surgery.  One of the most common surgical procedures we use to remove the herniated disc is called a minimally invasive microdiscectomy and is performed through a half inch incision on one’s neck or back. Patients are able to go home the same day as the procedure. Some disc herniations in the cervical spine are too large to remove from the back of the neck. These can be removed by going through the front of the neck with either a cervical disc replacement or anterior cervical discectomy and fusion.