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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 CAT scans have been replaced
by MRI.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
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When bed rest fails
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When centrally placed discs compress the cauda causing urinary dysfunction
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Motor dysfunction caused by spinal cord compression.
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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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