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Herniated cervical or lumbar discs

Disc material can herniate laterally leading to compression of the nerve roots and radicular pain. It may herniate more centrally leading to spinal cord or cauda injury. Herniations occur mainly in the cervical or lumbar regions, thoracic cord herniations are rare.

Clinical manifestations

Pain: herniated disc by itself usually does not cause any pain. Pain occurs when the membrane on the outside of the spinal cord or spinal nerves is irritated. Pain or numbness may occur in the area of the body to which the nerve travels. For example, a herniated disc that presses on one of the nerve roots of the sciatic nerve may cause pain and numbness in the leg, a condition called sciatica. Sciatica is the most common symptom of a lumbar herniated disc.

Loss of function: such as muscle (in the limbs) weakness or altered sensation, can be caused by pressure from the herniated disc on the nerve roots or spinal cord.

You may also develop back pain along with a herniated disc and sciatica. Like sciatica, this associated back pain usually subsides over time.

Diagnosis

Disc protrusion is usually detected by MRI and is seen mainly in the lower 3 cervical discs and in LV4 and LV5, S1. CAT scans have been replaced by MRI.

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Treatment

Nonsurgical treatment

Pain control

One or two days of rest in bed on a firm surface or mattress may ease severe pain caused by disk problems. If not, then pain killers may be useful. Cold or heat therapy may also be used to control pain. Transcutaneous electrical nerve stimulation (TENS) delivers an electrical current to key points on a nerve pathway. This is thought to induce the release of pain-inhibiting molecules (endorphins) or blocks pain fibers that carry pain impulses. Acupuncture and chiropractic treatment may help to control the pain.

Once the pain improves, one can begin the process of strengthening and stabilizing the back through exercise and physical therapy.

Surgical treatment

  • When bed rest fails

  • When centrally placed discs compress the cauda causing urinary dysfunction

  • Motor dysfunction caused by spinal cord compression.

  • Some also recommend surgery for motor dysfunction caused by root compression.

The goals of surgery are to keep the herniated disk from pressing on and irritating nerves and to relieve pain. Open decompression procedures.

Laminectomy

Laminectomy involves removing a small amount of the back part of the bone over the spinal canal (lamina) to relieve pressure on a nerve or allow the surgeon access to a disk that's pressing on a nerve. When performed for a herniated disk, a laminectomy typically is done in conjunction with a diskectomy.

Diskectomy

A diskectomy involves the removal of part of a disk to relieve pressure on a nerve. An incision is made, and the herniated portion of the disk and any pieces that have broken loose are removed.

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