Disc Herniation (Prolapsed Intervertebral Disc)
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TOPICS
1. What is a Prolapsed Intervertebral Disc? 2. What causes Prolapsed Intervertebral Disc? 3. Symptoms of a Prolapsed Intervertebral Disc? 4. When should I see a Pain Specialist? 5. What tests can be done to confirm a Prolapsed Intervertebral Disc? 6. How are Prolapsed Intervertebral Disc treated? 7. What is an Epidural Steroid Injection? What is a Prolapsed Intervertebral Disc?
The spine is comprised of vertebrae cushioned by discs. These discs are composed of a tough tough outer layer called the annulus and an inner layer called the nucleus pulposus. Functionally, these discs act as shock absorbers. Herniated discs, also known as bulged, slipped, or ruptured discs, occur when a fragment of the disc nucleus is displaced into the spinal canal through a tear or rupture in the annulus. This further leads to inflammation and compression of the spinal nerve. Most commonly, disc hernias occur in the lumbar spine (lower segments) but it can happen along any part of the spine (cervical & thoracic segments). What causes Disc Herniation?
Disc herniation usually occurs as a result of a strain or twisting injury. In younger patients, this is often due to a single event such as during lifting a heavy object. In some of these instances, patients report feeling a "pop" sensation preceding the low back pain / leg pain. In older patients, this may occur without a significant injury. This is because disc material degenerates as one ages leading to disc bulge. A seemingly insignificant strain or twisting movement can also cause a disc to rupture or herniate, resulting in pain. Certain individuals may be predisposed to this condition. The risk factors for disc herniation include:
Symptoms of Disc Herniation
Common Symptoms (Cervical Spine):
Common Symptoms (Lumbar Spine):
When should I see a Pain Specialist?
If you suspect you have a herniated disc herniation, you should see a Pain Specialist. In the early period, your Pain Specialist will help you to ensure that there is no serious medical illness. You will also be prescribed some medications to help you to get better. If your symptoms exceed 4 to 6 weeks or if there are significant abnormalities detected on your history / physical examination, additional testing will be performed. An example of an additional testing will be X-rays or MRI scans of the back. What tests can be done to confirm a Disc Hernia?
Tests are not required for all patients with suspected Disc Hernias. If your symptoms resolve quicky, imaging is not required. However, if your symptoms are severe, progressive or prolonged, you may need further tests such as:
How are Herniated Discs treated?
While most herniated discs don't require surgery, seeking medical care is crucial for accurate diagnosis and management. General guidelines include limiting activities, encouraging walking, and avoiding bed rest. Urgent evaluation is necessary for signs of significant weakness, loss of feeling, or critical area control loss. Non-surgical approaches are often the initial strategy, including low activity, anti-inflammatory medication, and physical therapy. Interventional treatment options (Eg. Epidural Steroid Injections & Nucleoplasty) Surgery becomes an option if conservative and interventional treatments fail. Lumbar spine surgery may involve laminotomy or discectomy, with spinal fusion in complex cases. Artificial disc surgery can also be considered for specific candidates. What is an Epidural Steroid Injection?
An epidural steroid injection is a minimally invasive procedure commonly used to relieve pain associated with inflammation and irritation of spinal nerves in the neck, mid-back, or lower back regions. During the procedure, a small needle is carefully inserted into the epidural space, which surrounds the spinal cord and nerve roots. A combination of corticosteroid medication, which reduces inflammation, and a local anesthetic, which provides temporary pain relief, is then injected into this space. The corticosteroid medication works by decreasing inflammation and swelling around the spinal nerves, thereby alleviating pain and improving mobility. ESIs are often recommended for individuals experiencing symptoms such as radicular pain (pain radiating down the arms or legs), numbness, tingling, or weakness caused by conditions such as herniated discs, spinal stenosis, or degenerative disc disease. |
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