What is it?
The intervertebral disc is a cushion or shock absorber between the bones of the back and neck. A disc consists of two separate components. A jelly-like center is surrounded by rings of cartilage. With wear and tear or injury, some of the rings of collagen are weakened. DISC HERNIATION occurs when some of the jelly-like central disc material pushes through a defect in the outer portion of the disc.
The symptoms present from a disc herniation can be quite varied. A person may not experience any significant pain. However, most people with a disc herniation experience some degree of neck or back pain. The location and severity of the symptoms are dependent upon what structures are irritated. For example, if the disc presses against a nerve root, one can develop “referred pain” (pain down the arms with a neck herniation and down the legs with a back herniation). This pain may worsen or improve with certain actions or changes in body position.
Progressive weakness in the arm or leg affected by the disc herniation. Progressive loss of sensation. An inability to control urination or bowel movements. This may mean an inability to pass urine or wetting or soiling clothing.
Initial treatment of a disc herniation focuses on pain control. Patients are usually given anti-inflammatory medications such as ibuprofen or naproxen and non-narcotic pain medications. The second step is modification of certain activities which are likely to increase pain. Prolonged bed rest is not recommended. Specific exercises can decrease symptoms dramatically, so physical therapy with a therapist specializing in spine-care is initiated. For more severe and persistent pain, epidural steroid injections are often used to provide pain relief and decrease inflammation. Dr. James Natalicchio routinely performs in office procedures including a full complement of therapeutic injections.
This condition is generally manageable with appropriate treatment. In 80 to 90 percent of cases the above measures combined with approximately 4 to 6 weeks of time to heal are enough to manage symptoms. Only when symptoms remain unmanageable are more invasive procedures considered. These may include minimally invasive procedures to decompress the disc or surgery.
Although aggressive conservative treatment plans are very effective, a patient with a disc herniation is always at a higher risk for recurrent episodes of back or neck pain. Exercise and modifying one’s activities can sometimes be the best way to achieve the highest degree of function, minimize symptoms and reduce the risk of future problems. Patients should use common sense and ease into more strenuous activities. Most people are able to return to their former jobs and recreational activities without restriction. It is helpful to follow a regular exercise program specifically designed by a physical therapist and your spine physician.