Herniated Disc
A good way to about an intervertebral disc is to compare it to a jelly donut. The outer portion is thicker, and the inside is more gelatinous. The outer part is called the “annulus fibrosis” and the inner part is called the “nucleus pulposis”.

It is natural for the annulus to develop small fissures over time, usually directed posteriorly toward the nerves. The inner nucleus can leak through these passages and place pressure on the nerves. We call this a herniated disc.

Nerves do not like any pressure on them whatsoever. The body protects them by encircling them initially with water (cerebrospinal fluid), and later by bone. The bony protection can become a problem when there is pressure within the spinal canal.

When the nucleus pulposis leaks posteriorly through the annulus fibrosis, it can put pressure on the nerves. This can cause pain, numbness, or weakness in the distribution of the nerve.

Disc herniations can occur for a number of reasons. They are common after lifting and twisting injuries. However, at times they can occur with a simple sneeze, or for no clear reason at all.

Microdiscectomy - The majority of thoracic and lumbar disc herniations, and a fair number of cervical disc herniations can be treated by this method. The goal is to take the pressure off the nerve by approaching it from the back of the spine. In the cervical and thoracic spines, the procedure is a bit more difficult because the spinal cord is present. In the lumbar spine, the spinal cord ends and separates into individual nerve roots. Nerve roots tolerate movement much more than the spinal cord.

Microdiscectomy is usually an outpatient procedure with an excellent success rate.

In the cervical spine, it is often necessary to remove the whole disc to take the pressure off the nerves. In the past, our only option was an anterior cervical discectomy and fusion. In this procedure we remove the disc, decompress the nerves, and place a bone spacer in the gap between the bones.

In the last 2 years, a new, promising alternative was developed. Cervical disc replacement may allow the interspace to continue to move, to avoid placing unnecessary pressure on the levels above and below the fusion. Additionally, there is no need to wait for the bones to fuse together, so rehabilitation tends to be shorter.

Treatments
Studies show that over 90% of patients get better on their own. However, physical therapy and anti-inflammatory medications, when indicated, can speed the rate of recovery.

When pain radiating down the leg is the most serious concern, we often recommend a lumbar spine MRI to find out exactly where nerve compression is located.

Treatment options:

Conservative management - this includes physical therapy and anti-inflammatory medications. At times we recommend acupuncture, massage, and other treatments to relieve your pain. A core strengthening program can help you recover quicker, and help you prevent a similar injury in the future.

Epidural steroid injections - Injections can be very helpful in removing the majority of the radiating leg pain, and a portion of the back pain. These steroids occur naturally in your body. Unlike oral medications that place the same amount of medication in your shoulder and your spine, epidural injections place the inflammatory directly in the problem area. Injections to not remove the pressure on the nerve, but may keep the nerve from swelling in an already tight place. The goal is to help you find pain relief until your body can take care of the problem on its own.