Overview

 

Herniated disc surgery is an invasive type of treatment used for those who have herniated discs in their backs. However, surgery is usually reserved for the most serious cases. For example, a person with pain that has persisted after four to six weeks of treatment using other methods may be a good candidate for herniated disc surgery. This may be particularly true when weakness accompanies pain symptoms or when the person finds it difficult to keep up with everyday activities. In other cases, a doctor may alert the patient to the fact that disc surgery is an option after viewing the results of diagnostic tests, such as an magnetic resonance imaging (MRI) test.

There are different types of herniated disc surgery. When a person has a discectomy, his doctor makes a small incision and removes disc tissue that is applying pressure to a nerve or the spinal cord. Some experts consider this the most successful of all the herniated disc surgeries. It is also considered the most common.

Another type of herniated disc surgery is called a percutaneous discectomy. This surgical procedure is used to treat people who have bulging or ruptured discs. To remove herniated disc tissue using this method, a surgeon makes a small incision in the patient's back and uses a special tool for removal. Unfortunately, this is considered one of the least successful methods of treating herniated discs

Regional distribution

Cervical disc herniation

MRI scan of cervical disc herniation between fifth and sixth cervical vertebral bodies. Note that herniation between sixth and seventh cervical vertebral bodies is most common. Cervical disc herniations occur in the neck, most often between the fith & sixth (C5/6) and the sixth and seventh (C6/7) cervical vertebral bodies. Symptoms can affect the back of the skull, the neck, shoulder girdle, scapula shoulder, arm, and hand. The nerves of the cervical plexus and brachial plexus can be affected.


Thoracic disc herniation

Thoracic discs are very stable and herniations in this region are quite rare. Herniation of the uppermost thoracic discs can mimic cervical disc herniations, while herniation of the other discs can mimic lumbar herniations.


Lumbar disc herniation

Lumbar disc herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttocks, thigh, and may radiate into the foot and/or toe.

Causes

Disc herniations can occur from general wear and tear, such as jobs that require constant sitting, but especially jobs that require lifting. Traumatic (quick) injury to lumbar discs commonly occurs from lifting while bent at the waist, rather than lifting while using the legs with a straightened back. Minor back pain and chronic back tiredness is an indicator of general wear and tear that makes one susceptible to herniation on the occurrence of a traumatic event from bending to pick up a pencil or a traumatic injury from a fall. When the spine is straight, such as standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 17 psi (lying down) to over 300 psi (lifting with a rounded back).

Smoking is a major risk factor as the chemicals within smoke cause diminished nutrition and oxygenation of the discs leading to dehydration & degeneration which can then proceed to herniation



What are the symptoms of a herniated disc?

When the spinal cord or spinal nerves become compressed, they don't work properly. This means that abnormal signals may get passed from the compressed nerves, or signals may not get passed at all. Common symptoms of a herniated disc include:

Electric Shock Pain -

Pressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms, when the compression is in the lumbar (low back) region, the shocks go down your legs.

Tingling & Numbness -

Patients often have abnormal sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful electric shock sensations.

Muscle Weakness -

Because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness. Nerve irritation can also be tested by examining reflexes.

Bowel or Bladder Problems -

These symptoms are important because it may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency, and your should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.




How is the diagnosis of a herniated disc made ?

Most often, your physician can make the diagnosis of a herniated disc by physical examination. By testing sensation, muscle strength, and reflexes, your physician can often establish the diagnosis of a herniated disc.

Treatment of Herniated Disc

Non Surgical Treatment

If after non-surgical treatment the patient still has intolerable pain, or if there is evidence of neurological deficit (e.g. weakness in the calf muscles) then we may recommend surgery to treat the disc herniation. Non-surgical treatments can include the use of electrical stimulation, pain medication, cold and hot compresses, a decrease in the activity that typically causes pain, acupuncture, and visits to a chiropractor. Some of the more common surgical procedures are called laminotomy, laminectomy, discectomy, and micro discectomy

Surgical Treatment of Herniated Disc

Nucleoplasty

Nucleoplasty is a newly developed procedure designed to decompress herniated discs. It is sometimes referred to by the name percutaneous discectomy. This procedure is minimally invasive, using a super thin catheter to gain access to the bulging disc.Read More…

Spine fusion is rarely necessary when a disc is herniated for the first time. If necessary, the space left by the removed disc may be filled with a bone graft - a small piece of bone usually taken from the patient’s hip. The bone graft or a bone substitute is used to join or fuse the vertebrae together. In some cases, specially designed instrumentation (such as rods or screws) may be used to help promote fusion and to add stability to the spine.

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