Spotting the Symptoms of a Herniated Disc
Disc herniation is a common spinal problem, particularly among older adults who have sustained wear and tear damage to the delicate components of the spine. When an intervertebral disc tears or ruptures, the gel-like material on the inside of the disc can push through the tear. Not all patients with a herniated disc will require spine surgery. An orthopedic surgeon will typically recommend conservative treatments first, followed by spine surgery if symptoms are not resolved.
Symptoms of a Lumbar Herniated Disc
Most often, herniated discs occur in the lumbar region, which is the lower back. A lumbar herniated disc can cause pain in the lower back, buttocks, thighs, and calves. Sometimes an area of the foot may also be painful following a herniated lumbar disc.
Symptoms of a Cervical Herniated Disc
Patients with a herniated disc in the cervical region, or upper portion of the spine, may experience pain in the neck, shoulder, and arm. The pain may worsen with certain movements and activities, such as coughing.
Symptoms of Nerve Impingement
Patients who experience intense pain that radiates to other areas of the body are likely to have nerve impingement. When the gel-like material protrudes through the tear in the disc, it can compress and irritate the nerves. In addition to pain, nerve impingement can lead to numbness, tingling, and muscle weakness.
Symptoms of Cauda Equina Syndrome
In rare cases, disc herniation can lead to cauda equina syndrome. The cauda equina is a group of nerve roots just below the waist. If these nerves are compressed, emergency medical attention is required to prevent the patient from suffering from permanent weakness or paralysis. Patients who experience symptoms that worsen to the point of debilitation, bowel or bladder dysfunction, or saddle anesthesia should seek emergency medical care.
Treatment options for Herniated Disc
Usually, your spine specialist will recommend conservative herniated disc treatment approaches to start. These include rest, physical therapy, ice and heat, spinal manipulation, pain medications, and epidural injections. Most patients require the use of multiple conservative treatments to get pain relief and usually find the best combination after a process of trial and error. Conservative treatments are most effective during the first six weeks of pain.
Generally, patients with herniated discs are advised to try a nonsurgical approach first. A spine specialist might recommend a combination of rest and physical therapy. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain. Some patients may require muscle relaxants or corticosteroids. Others might benefit from injection therapy, such as epidural injections. It’s important to be fully aware of the proper use of these medications and their potential side effects. Most patients can find relief of their symptoms with a nonsurgical approach. However, if your symptoms do not improve within about six to 12 weeks, you may be referred to an orthopedic surgeon. Sometimes, spine surgery may be considered sooner than this, depending on the severity of pain and level of functioning.
For some patients with herniated disc pain, rest is all that is needed for recovery. Sometimes, combining rest with heat and ice treatments can provide further relief. Rest is most effective for symptoms during the early stages, before the condition becomes exacerbated.
There are a number of pain medications that can be used to manage herniated disc symptoms. Some people find over-the-counter pain medications to be effective, while others benefit from prescription pain pills, corticosteroids, and muscle relaxants. Injection therapy, such as epidurals, can also provide pain relief. Oftentimes, your doctor may need to try a few different medications before finding the right one for you.
When conservative herniated disc treatment is not effective, or if it initially relieves your symptoms but then they return, surgery may be necessary. Microdiscectomy is a type of minimally invasive spine surgery in which the portion of the disc that is pressing on the nerve is removed. This relieves the pressure on the nerves that is causing pain and allows the nerves to heal. In some cases, a spinal fusion is also performed to fill the space where the disc was removed. Your spine surgeon will determine which procedure is right for you based on the location of your herniated disc. Although surgery is not generally the first line of treatment for herniated discs, some patients require early surgical treatment if the herniated disc is causing worsening leg weakness or loss of bladder or bowel control
To understand the surgical approach to herniated disc treatment, it can be helpful to learn exactly how this condition can cause pain. When the inner material of the disc protrudes through the exterior, it can sometimes impinge upon a nearby nerve, such as the sciatic nerve. This irritates and inflames the nerve, and causes pain and other symptoms. An orthopedic surgeon can relieve pressure on the nerve by removing part of the spinal disc that is touching the nerve. This type of surgery is known as a discectomy.
What You Should Know About Minimally Invasive Spine Surgery ?
Before surgeons were able to use minimally invasive techniques on the spine, patients endured extensive surgeries and long recovery periods. Now, however, an increasing number of neck and back surgeries can be performed with these advanced techniques. If you’ve been experiencing persistent, severe back pain, you can consult an orthopedic surgeon to find out if minimally invasive back surgery is right for you.
There are many advantages to having minimally invasive spine surgery as opposed to traditional open surgery. During an open surgery, the doctor creates a five-to six-inch incision and pulls the muscles to the side to access the spine. This major adjustment of the muscles can inflict soft tissue damage. Patients who undergo open spine surgery typically have more pain and a longer recovery time as a result. In contrast, minimally invasive surgery involves creating small incisions, which minimizes soft tissue damage. With minimally invasive back surgery, patients may experience less pain, less bleeding, and a shorter recovery time.
Many different spine surgeries can be performed with minimally invasive techniques. For example, an orthopedic surgeon could perform a lumbar discectomy or a posterior cervical discectomy with this approach. Discectomies are procedures to address disc herniation. Surgeons can also perform spinal fusion procedures with minimally invasive techniques.
Although there may be a reduced risk of complications with minimally invasive approaches, it’s important for patients to be aware that complications may still occur. These potential complications may include infections, bleeding, and nerve damage. Patients may rarely experience persistent pain at the surgical site or a recurrence of the symptoms the surgery was intended to resolve. Patients who smoke may be more likely to develop pseudoarthrosis after spine surgery. Any individual who is immobile for long periods of time after a surgery may be at risk of developing blood clots in the legs, which may break free and travel to vital organs.
What To Expect from Spinal Fusion Surgery ?
If you’ve been diagnosed with an unstable spine, abnormal spinal curvatures, spinal stenosis, or spondylolisthesis, your orthopedic surgeon might recommend that you undergo spinal fusion surgery. This type of spine surgery involves permanently fusing two or more vertebrae. This prevents any movement between these bones. Before undergoing spinal fusion surgery or any other surgical procedure, talk to your spine surgeon about what you can expect from the procedure and the subsequent recovery.
To prepare for this type of back surgery, you can expect to have an extensive consultation with the orthopedic surgeon. You may undergo some tests, such as imaging scans and blood tests.
You’ll need to disclose all of your medical conditions and any medications or supplements you take. Sometimes, patients are asked to discontinue drugs and supplements that have an anti-clotting effect. You should also discuss your use of any recreational substances, if applicable.You may be asked to temporarily cease alcohol consumption and to quit smoking to facilitate healing. The night before the spine surgery, you’ll need to stop eating and drinking at a certain time, usually midnight.
You’ll be placed under general anesthesia for this spine surgery, which means you’ll be asleep and won’t feel any discomfort. Often, the orthopedic surgeon will perform another procedure, such as a discectomy or laminectomy, before fusing the vertebrae. To fuse the vertebrae, he or she will apply a bone graft. Often, rods, screws, cages, or plates are also used to hold the vertebrae together as the bone graft heals.
Spinal fusion surgery patients can expect to remain in the hospital for several days following the procedure. You’ll receive pain medications to help you remain comfortable and you’ll receive nutrients intravenously. You can expect to work with a physical therapist to learn how to perform basic movements, such as getting out of bed, sitting, standing, and walking. After you’ve been discharged from the hospital, it’s important to follow your spine surgeon’s post-operative care instructions.
What Questions Should You Ask Your Doctor About Your Spine Surgery?
The decision to have spine surgery is not one that should be made lightly. As with any surgical procedure, it’s important for patients to have an in-depth understanding of the reasons for the procedure, the benefits and potential risks, and the steps you can take to prepare for the surgery. Before meeting with your orthopedic surgeon, consider writing a list of questions you have about the procedure.
Why Is this Procedure Right for Me?
One of the questions you may wish to ask your spine surgeon is why he or she is recommending a particular procedure. The doctor can explain the potential drawbacks to leaving your condition untreated, how a particular spine surgery will correct your condition, and what the benefits of the surgery are. In order for your orthopedic surgeon to determine whether you’re a good candidate for a surgery, he or she will need your complete medical history, including other medical conditions you have and medications you take.
What Are the Potential Risks?
Every medical procedure has the potential for side effects and complications, including spine surgery. Working with a fellowship-trained spine surgeon with extensive experience with spinal procedures can help reduce the potential for complications. However, it’s always important for patients to be aware of the possible risks.
What Should I Do to Prepare?
Following your spine surgeon’s pre-operative instructions carefully will improve your own safety during the procedure and can facilitate the recovery process. For example, your doctor may instruct you to discontinue certain medications for a period of time. You’ll also need to refrain from eating or drinking for a while prior to the procedure, and you’ll need someone to drive you home from the hospital and stay with you for a while. It’s highly advisable to place frequently needed items within easy reach so that you can avoid placing stress on your back.