Herniated Disc (Lumbar)

Herniation describes an abnormality of the intervertebral disc that is also known as a "slipped," "ruptured" or "bulging" disc. This process occurs when the inner core (nucleus pulposus) of the intervertebral disc bulges out through the outer, more fibrous layer of the disc (annulus fibrosis).

Symptoms

Back pain with radiating leg pain. There may also be radicular symptoms with pain, numbness, or weakness extending into the legs. If severe, loss of coordination and bowel or bladder incontinence may occur.

About this Condition

Herniation describes an abnormality of the intervertebral disc that is also known as a "slipped," "ruptured" or "bulging" disc. This process occurs when the inner core (nucleus pulposus) of the intervertebral disc bulges out through the outer, more fibrous layer of the disc (annulus fibrosis). If the protruding disc presses on a spinal nerve, the pain may spread to the area of the body that is served by that nerve.

Degenerative disc disease (DDD) is part of the natural process of growing older. As we age, our intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics. The outer fibers that surround the disc, called the annulus fibrosis, become brittle and are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink. The combination of damage to the intervertebral discs, the development of bone spurs and the gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the lumbar spine.

To a certain degree, this process happens to everyone. However, not everyone who has degenerative changes in their lumbar spine has pain. Many people who have "normal" backs have MRIs that show disc herniations, degenerative changes and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as a result of degenerative disc disease.

[Source: Medtronic]

This content is for your general education only. See your doctor for a professional diagnosis and to discuss an appropriate treatment plan.

Conservative Treatments

Medication and Pain Management

The goal when prescribing medications should be maximum reduction of pain and discomfort with minimal risk of overuse of the medications and avoiding side effects.

Non-steroidal anti-inflammatory medications (NSAIDs) include common over-the-counter drugs such as aspirin, ibuprofen and naproxen among others. These drugs are potent long-term pain reducers that work without concerns of dependence.

Opioid therapy to control chronic back pain is less ideal because of potential toxicity to the body and physical and psychological dependence. Treatment by this class of drugs should generally be a short term option when patients do not respond to alternatives.

Pain can often be reduced through the use of muscle relaxants, anti-seizure pain medications such as Neurontin, Topamax, and Lyrica, anti-depressants, and oral steroids.

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Physical Therapy / Occupational Therapy

Physical and occupational therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a therapist can design a rehabilitation program to help prevent recurrent injuries.

These programs often include heat, cold and electrotherapy to help alleviate pain, decrease swelling, increase strength and promote healing. Methods include therapeutic exercise, manual therapy, functional training and use of assistive devices and adaptive equipment to increase strength, range of motion, endurance, wound healing and functional independence.

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Injections

In some cases, your doctor may give you an injection of a corticosteroid to help relieve your pain and reduce inflammation. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation, which in turn relieves pressure and pain. They are most effective when used in conjunction with a rehabilitation program. In addition, corticosteroids can cause serious side effects, so the number of injections you can receive is limited—usually no more than three in one year.

A steroid is often combined with an anesthetic and injected into the area around the irritated spinal nerves that are causing the pain. This area is called the epidural space, and it surrounds the sheath-like protective membrane, or dura, that covers the spinal nerves and nerve roots. Steroids reduce nerve irritation by inhibiting production of the proteins that cause inflammation.  The anesthetic blocks nerve conduction in the area where it's applied, numbing the sensation of pain.

An epidural spinal injection may be done either for diagnostic or therapeutic reasons. By injecting medication around a specific nerve root, your doctor can determine if that particular nerve root is the cause of the problem. When administered for therapeutic reasons, a spinal epidural injection may provide long- or short-term relief, anywhere from a week to several months. In some instances, an epidural spinal injection may break the cycle of inflammation and provide permanent relief.

It's important to note, however, that an epidural spinal injection is typically not considered a cure for symptoms associated with spinal compression. Rather, it's a treatment tool that a doctor can use to help ease pain and discomfort as the underlying cause of the problem is being addressed through a rehabilitative program such as physical therapy, or while the patient is considering surgical treatment options.

Surgery

METRx Minimally Invasive Hemilaminectomy

A hemilaminectomy is a spine surgery that involves removing part of one of the two laiminae on a vertebra to relieve excess pressure on the spinal nerve(s) in the lumbar spine, or lower back. A hemilaminectomy can be performed to relieve symptoms such as back pain and radiating leg pain.  A METRx hemilamectomy is a minimally invasive procedure performed utilizing METRx technologies.

In a traditional open lumbar laminectomy the two laminae and spinous process of a vertebra are removed to relieve excess pressure on the spinal nerves in the spine. The term laminectomy is derived from the Latin words lamina (thin plate, sheet or layer), and -ectomy (removal). A laminectomy removes or “trims” the lamina (roof) of the vertebrae to create space for the nerves leaving the spine.

METRx Microdiscectomy

A minimally invasive discectomy is an operation that involves using either endoscopic or microscopic techniques to access and treat the spine. Only that portion of the herniated disc, which is pinching one or more nerve roots, is removed. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal).

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Open Laminectomy

Laminectomy is an operation that involves removing a portion of the bone over and/or around the nerve roots to give them additional space. Your surgeon removes a portion of the lamina, the bony rim around the spinal canal, if it is contributing to pressure on the spinal cord or nerve roots.

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Please keep in mind that all treatments and outcomes are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.