In between each of the vertebrae of the spine, there are discs that cushion the vertebral bones. These small discs have a tough outer layer (annulus) with a jellylike material on the inside (nucleus). A herniated disc occurs when a part of the jellylike nucleus pushes its way out into the small spinal canal through a tear in the harder outer layer of the disc. The spinal canal is not big enough to hold both that nucleus and the nerve, therefore the nerves of the spine may become compressed and cause a variety of symptoms.
Diagnosis and Nonsurgical Treatment of a Herniated Disc
The diagnosis of a herniated disc can be made several ways, most commonly on MRI after history and physical exam suggest this diagnosis. Once the diagnosis is made, there are a number of treatment options available.
Initial treatments for herniated disc include conservative measures such as rest, non-steroid anti-inflammatories, epidural steroid injections, and physical therapy. Many treatments are done in conjunction with physical therapy and medication in an effort to strengthen the muscles surrounding the spine and alleviate the painful symptoms of a disc herniation.
For those who have not found relief with conservative modalities, surgery may be an option.
Surgical Treatment of a Herniated Disc
Spinal surgery is generally considered when one or more of the following is present:
- Conservative measures have failed.
- Back pain radiates to the legs and buttocks. (Sciatica)
- Pain is constant and/or interferes with normal activity or quality of life.
- There are progressive neurological deficits such as weakness or numbness in the legs.
- There is difficulty with walking and standing.
Rarely, disc herniations can cause bowel and bladder dysfunction, loss of sensation in the groin area, and severe weakness to both legs (cauda equina syndrome). This is an emergency and patients should go to the emergency room immediately.
Fortunately, recent advancements in surgical technology has allowed many of these procedures to be performed using what is known as a Minimally Invasive Approach with the assistance of a microscope. With this more advanced approach, only a small incision is made (1-2 inches) in conjunction with real time X-ray technology (fluoroscopy) to access only the affected disc. Once this disc is accessed, the herniated portions can be removed, thus alleviating pressure on the spinal nerve. Most patients are up and walking shortly after their procedure and are able to go home the same day. This approach also shortens the recovery profile substantially and patients are able to return to work and physical activity sooner.
There are several types of surgery that can be performed and your procedure will be based on a variety of factors including your age, lifestyle and severity of injury. Your spine specialist should review which options are available and which would yield the greatest benefit.
The spine specialists at New Jersey Spinal Medicine and Surgery treat conditions of the cervical and lumbar spine using both non-surgical and surgical modalities. New Jersey Spinal Medicine and Surgery is led by Dr. Dante Implicito and Dr. John Koerner and has offices in Glen Rock and Maywood, NJ. Both physicians have extensive training and experience in the utilization of Minimally Invasive Spine Surgery techniques as well as non-surgical techniques.
While here at New Jersey Spinal Medicine and Surgery, all steps in your treatment will be clearly reviewed with you by our outstanding and expert team. Our goal is to ensure your return to the healthy and active lifestyle you enjoyed in the quickest and most effective way possible. Each patient is an individual and must be treated like an individual. Our doctors emphasize a personalized and individualized treatment plan for all of their patients that aim to ensure that each patient is educated and informed when it comes to their procedure.