FAQs on Herniated Disc – Info from a Phoenix and Scottsdale Pain Management Clinic
The spine consists of irregular shaped bones called vertebrae, which are separated from one another by intervertebral discs. These quarter-sized discs provide shock absorption, allow for movement, and provide flexibility of the spine. The inner portion consists of a soft gel-like center called the nucleus pulposus, and the outer portion is called the annulus fibrosus.
Who is at risk for a herniated disc?
Certain people are most at risk for a herniated disc than others. Middle-aged people who do strenuous activity are at risk. Additionally, the disc deteriorate with age, narrowing the spaces between each vertebra. This increases the risk for herniation. Other risk factors are:
- Back or neck injury
- Lifting improperly
What body region is at risk for herniated disc?
The most common area of herniated disc is between the 4th and 5th lumbar vertebrae. Cervical disc herniations tend to occur between the 5th and 6th neck vertebrae or the 6th and 7th ones.
What are the symptoms of a herniated disc?
Herniated disc cause symptoms on one side of the body. The protruding disc will press on spinal nerves, resulting in pain, weakness, and numbness of the extremity supplied by the affected nerve. Other symptoms are low back pain, tingling of the buttock or leg, and shooting pain (sciatica). With a cervical disc herniation, pain will shoot down one arm, and cause weakness of the extremity.
How is a herniated disc diagnosed?
The diagnosis of a herniated disc depends on the symptoms of the condition. To evaluate someone with back problems, the diagnosis includes x-rays of the spine, a computed tomography, magnetic resonance imaging (MRI). A myelogram involves injecting a special contrast dye into the spinal fluid, followed by radiographs of the spinal canal. For additional evaluation, electromyography is done to evaluate function of the muscles and nerves, and nerve condition studies show how well electrical signals are transmitted by the nerves.
How is a herniated disc treated?
Treatment for a herniated disc will depend on the severity of the condition, as well as the mobility issues. Options include:
- Medication – For nerve injury and neuropathic pain, medications include gabapentin, pregabalin, and duloxetine. Anti-inflammatory agents will decrease inflammation and pain, such as ibuprofen, naproxen, and ketoprofen. For severe pain, narcotic analgesics include oxycodone and hydrocodone.
- Epidural steroid injection (ESI) – With this procedure, a corticosteroid agent is injected into the space outside of the spinal fluid sac (epidural region). This will reduce swelling, alleviate pain, and eliminate inflammation. The ESI is proven to be around 90% effective, based on current studies.
- Physical therapy – To strengthen the back and improve flexibility, physical therapy is used. The therapist works with the patient 2-3 times each week for several weeks.
- Selective nerve root block (SNRB) – For people with nerve compression and sciatica, this block has an 80% efficacy rate. The doctor will inject a long-acting anesthetic agent near the nerve root to block pain signal transmission.
- Acupuncture – Based on ancient Chinese therapy, acupuncture is useful for many forms of chronic back pain. The practitioner inserts tiny needles along the skin and subcutaneous tissue of the back to cause the release of endorphins (special neurotransmitters that block pain). In addition, this therapy helps restore energy balance and flow in the body. Studies show that acupuncture is superior to placebo treatment for back pain.
- Radiofrequency denervation – For this procedure, radio waves are used to interrupt nerve signals and destroy a portion of the nerve root. According to a recent clinical study, this procedure was found to be effective for long-term therapy related to radicular discomfort.
- Transcutaneous electrical nerve stimulation (TENS) – This procedure involves the use of a small device to deliver electrical current for nerve signal interruption. With a 75-90% success rate, the use of TENS is popular for treating low back pain.
- Spinal cord decompression therapy – This procedure involves the use of a specialized table to decompress the intervertebral disc that is painful, and it also elongates the spine to ease pain. A computerized unit controls the force and allows for precise controlled movements.