Herniated Discs

Overview

Your spine is made up of 33 vertebrae. Between your vertebrae is a kidney shaped intervertebral disc.  These allow for motion of your spine and serve as shock absorbers. A healthy intervertebral disc is comprised of 80% water. There are two main components to a disc. The outer fibrous ring is called the annulus fibrosus and contains layers of fibrocartilage and collagen. The inner portion of the disc is called the nucleus pulposus and is made of loose fibers in a mucoprotein gel. It is gel-like and has an appearance similar to crab meat. When an object is lifted, the force is transmitted directly thru the center of the disc and then redistributed radially to the outer fibrous rings.  The outer rings help to resist deformation.  It is this combination that enables the disc to act like a shock absorber.

  • What causes a disc to rupture or herniate?

    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.

  • What are the signs and symptoms of a herniated disc?

    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.

  • How do you diagnose a herniated disc?

    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.

  • What is the treatment for a herniated disc?

    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.

“Have already recommended Dr Stone to someone else from my office who is calling to set an appointment.”

Bob Saunders, Healthgrades (Dec 21, 2017)

“I don’t typically write reviews… but when your health and well-being is impacted so dramatically I feel it’s important. For over a year and a half I suffered from lower chronic back pain. I’ll spare the details… but the pain got so debilitating that I would have to get a wheel chair to make it through the airport on business travel. Sleeping on the couch sitting up became a way of life. I’m now about 90 days post-op and I ran for the first time in 6 months, pain free today! Dr Stone performed a discectomy and lamanectory on me; my only regret was that I didn’t have the procedure done a year ago. Pain level went from a 9 to post-op 2, overnight. Within 12 hours I was back to work. I can’t say enough positive things about the entire experience. Happy to be standing straight again and thankful for a wonderful surgeon!”

Chad Mitchell, Google (May 2018)

“Sometimes it seems as if people who have had negative experiences post about it more quickly then the people who have had great experiences. Therefore, I feel the need to RAVE about the great care and treatment Dr. Stone and his staff provided my father! My father was in tremendous back pain due to a herniated disc pressing on his nerves. He was seen by a couple of doctors, one even a previous surgeon of his, and yet they both said they couldn’t get him in for at least 2 weeks. Did I mention that he was in SEVERE pain?!?! (I followed up by calling his previous surgeon’s office and basically begging them to get him in sooner. The receptionist was rude and not at all empathetic). When I called ProOrtho, the experience from the first phone call was 100% different. I got Ashley on the phone, she is an amazing receptionist–she listened to my whole story and got my father in with Dr. Stone with a bit of juggling, right away! He was in so much pain that Heather, Dr. Stone’s assistant was also able to shuffle things around and get him in earlier than scheduled. Dr. Stone met with my father, assessed his pain and MRI and was able to get him in for surgery the next day! UNBELIEVABLE. It couldn’t have gone more smoothly or better. Post surgery we had several questions, and between Ashley, Heather, and Dr. Stone, they were addressed and answered quickly and thoroughly! So glad that we were referred to Dr. Stone and his office–would highly recommend!!!! Also, am a big believer that a receptionist plays such a big role in one’s opinion of a business–Ashley was amazing and presented a great, helpful image of ProOrtho from the first phone call!!! Thanks to all of you!”

Anonymous Reviewer, Vitals (December 24, 2015)