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    • Larry L. Teuber, M.D.
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Herniated Disc

Back pain, leg pain, or weakness of the lower extremity muscles may be signs of a herniated disc. The cushion that sits between the spinal vertebra is pushed outside its normal position when disc herniation occurs. The spinal nerves are very close to the edge of spinal discs, this is the major problem that occurs with a herniated disc.

Possible Causes

As the spinal disc loses elasticity, it may rupture. If the disc ruptures, a portion of the spinal disc is pushed outside its normal boundary, this is known as a herniated disc. As a herniated disc swells out from between the vertebrae, the spinal nerves and spinal cord may become pinched. There is typically additional space around the spinal cord and spinal nerves, however if enough of the herniated disc is pushed out of place, then these structures may be squeezed together. The nerves may become pinched when the herniated disc breaks and pushes out. A herniated disc may occur abruptly as a result of a fall or an accident, or may occur gradually with recurring strain of the spine. In some cases, people who experience a herniated disc already have spinal stenosis, a problem that brings about narrowing of the space around the spinal cord and spinal nerves. With a herniated disc, the space for the nerves is further reduced, and exasperation of the nerve results.

Possible Symptoms

• Electric shock pains may result, as the compression occurs in the cervical (neck) region, the pain shoots down your arms, when the compression occurs in the lumbar (low back) region, the pain shoots down your legs.
• Unusual sensations such as tingling, numbness, or pins and needles may be experience.
• Due to the nerve irritation, signals from the brain may be interrupted causing muscle weakness.
• It is important to not ignore symptoms such as bowel or bladder problems, as this may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a danger signal and you should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.
• The irritation of the nerve from the herniated disc causes all of these symptoms.

Diagnostic Methods

Evaluation of back and neck pain requires a physician experienced in diagnosing spinal conditions. The work-up begins with a detailed history and physical examination. Your medical history helps your doctor understand your back and neck pain, and the influence of your lifestyle in contributing to your pain.

During your physical exam, your neurosurgeon examines your spine and neurological system to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted. Diagnostic tests may be ordered to confirm the location and source of your pain.

X-rays

The first step is usually a set of X-rays. X-rays show the bones (vertebrae) of the spine.

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to generate highly-detailed pictures of the inside of your body. The MRI depicts soft tissues of the muscle and discs as well as nerves. These images help your neurosurgeon provide a more accurate diagnosis. This type of imaging is very safe and usually pain free. In most cases, injections are not required. However, in some situations, a contrast agent may be needed to enhance the ability of the MRI to see into your body.

Myelogram Followed by CT

A myelogram determines any decreases or blockages in the flow of cerebral spinal fluid (CSF) around your spinal column. It is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected and a series of X-rays taken. Once the myelogram is completed, you are sent for a CT scan.

Intrathecal CT

Intrathecal CT determines blockages or flow of cerebral spinal fluid around the spinal column. A local anesthetic is injected into the lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected. This procedure is followed by a CT scan, which takes a series of detailed pictures of the spinal area.

Electrodiagnostics

Electrical testing of the nerves and spinal cord may be performed before, during and after surgery. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your neurosurgeon in understanding how your nerves or spinal cord are affected by your condition.

Bone Scan with SPECT

Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also accurate for finding lesions for biopsy or excision. The uses of single-photon emission tomography (SPECT) techniques contribute significantly to the diagnostic accuracy of the scan. A small amount of radioactive material (tracer) is used to visualize all the bones in your body. Approximately three hours after the tracer has been injected into a vein, a scan takes place.

Discography

Discography is a procedure used to determine the internal structure of your disc. It is performed by using a local anesthetic and injecting a dye into your disc under X-ray guidance. An X-ray and CT scan are performed to view the appearance of the disc composition to determine if its structure is normal or abnormal. In addition to your disc appearance, your doctor will note if you have pain with this injection.

Treatment

Unfortunately, while muscles can heal somewhat quickly, a torn or degenerated disc heals more slowly. On a more positive note, in many cases the pain and inflammation originating from damaged discs may be treated nonsurgically. Pain resulting from a herniated disc may be relieved by special extension exercises. It may surprise back pain sufferers to learn that specific exercises can help relieve their pain. Exercise can work like a vacuum to suck the center of the disc back into place, helping release pressure on the nerve. Nonsurgical treatment methods are always the best first option. This will most likely involve working with a physical therapist. Your PT will help develop a customized exercise program that involves specific stretches and extension movements for you. Unfortunately, while muscles can heal somewhat quickly, a torn or degenerated disc heals more slowly. Reducing the inflammation and strengthening the musculature surrounding the damaged disc to increase support is a nonsurgical method.