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Herniated Spinal Disc

Millions of people suffer from neck, shoulder, and arm pain. While there are numerous conditions that can result in this type of pain, a common cause is a herniated disc. Discs, which act as shock absorbers for the spine, are located in between each of the vertebrae in the spine. Each disc contains a tire-like outer band (called the annulus fibrosus) that surrounds a gel-like substance (called the nucleus pulposus).

Axial view of Intervertebral Disc.

A disc herniation occurs when the outer band of the disc breaks or cracks and the gel-like substance from the inside of the disc leaks out, placing pressure on the spinal canal or nerve roots. In addition, the nucleus releases a chemical that can cause irritation to the surrounding nerves causing inflammation and pain.

Symptoms
The symptoms of a herniated disc might include:

  • Dull or sharp pain in the neck or between the shoulder blades, which can intensify in certain positions or after certain movements.
  • Pain that radiates down the arm to the hand or fingers (this is called radiculopathy).
  • Numbness or tingling in the shoulder or arm.

How Do Discs Herniate?
Most disc herniations occur as a result of sudden stress. This occurs during movements resulting in sudden flexion, extension, or twisting of the neck, such as during a fall or auto accident. Sometimes herniations occur gradually, over weeks or months. However, there are risk factors that can contribute to the chances of a disc herniation, including:

  • Aging. As we get older, discs gradually dry out, affecting their strength and resiliency.
  • History of major or minor trauma to the spine.
  • Lifestyle choices. Lack of regular exercise, not eating a well-balanced diet, and tobacco use substantially contribute to poor disc health.
  • Poor posture, incorrect and/or repetitive lifting or twisting can place additional stress on the spine.

The Stages of a Disc Herniation.

Diagnosis
Good treatment is always based on an accurate diagnosis. The comprehensive diagnostic process includes:

  • Medical history. You doctor will talk to you about your symptoms, how severe they are, and what treatments you have already tried.
  • Physical examination. You will be carefully examined for limitations of movement, problems with balance, and pain. During this exam, the doctor will also look for loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of spinal cord damage.
  • Diagnostic tests. Generally, doctors start with plain x-ray films, which enable them to rule out other problems such as infections. CT scans and MRIs are often used to give three-dimensional views of the lumbar spine and can help detect herniated discs.

Non - Operative Treatment
The good news is that most cases of disc herniation do not require surgery! There are a number of non-surgical treatments that can help relieve symptoms. These include the following:

  • Pain medications such as anti-inflammatories to reduce swelling and pain, muscle relaxants to calm spasm, and narcotic painkillers to alleviate acute pain.
  • Heat/cold therapy, especially during the first 24-48 hours.
  • Physical therapy exercises such as gentle massage, stretching, and neck bracing or traction to decrease pain and increase flexibility.

In conjunction with these treatments, the medical staff will educate patients about risk factors to avoid, healthy posture, good body mechanics, and suitable exercises. Quality education can lead to a healthier spine in the long run.

Surgical Treatment
If non-operative measures do not work, surgery may be recommended.

Fortunately, many of these procedures can often be done utilizing minimally invasive techniques. Minimally invasive surgery uses smaller incisions and tiny specialized instruments such as microscopes and endoscopes.