What is a Herniated Disk?
The spine is a long column of vertebrae bones running from your neck to your lower back. These vertebrae form a protective cushion around your spinal cord, a delicate bundle of nerves that facilitate communication between the brain and body. Spinal vertebrae are separated by disks, soft but strong cushions that act as shock absorbers and facilitate spinal movement. Disks can weaken and herniate when the outer wall of the disk ruptures. A gel-like substance inside leaks out from the herniated site, leading to compression of the spinal cord or pinched nerves.
The pressure from herniated disks can cause pain, numbness, tingling, or weakness in different areas of the body depending on the affected nerves. Herniated disk symptoms include:
- Pain in the neck or lower back
- Radiating or shooting pain in the limbs on one side of the body
- Burning sensation
- Arm and/or leg weakness
- Muscle spasms
- Limb numbness and tingling, like your arm or leg has ‘fallen asleep’
- Difficulty walking
- Bladder control problems
The majority of herniated disks occur in the lower (lumbar) region of the spine, putting pressure on or damaging the sciatic nerve and causing sciatica. Those with sciatica often feel leg cramping, burning, weakness, numbness, and tingling. They may also experience bladder control problems.
Disks have high water content in children and young adults. As we age, disks lose water and become less flexible. As the disks shrink, the space between the spinal vertebrae narrows. A number of risk factors can contribute to disk weakening, making herniation more likely. These include:
- Improper lifting of heavy objects
- Trauma or sudden pressure on the spine
- Degeneration or aging of the spine
- Being overweight or obese, which places added stress on lower back disks
- Excessive alcohol consumption
- Genetic predisposition
Herniated Disk Care at MedStar Montgomery
Our team of experienced orthopedic surgeons at MedStar Montgomery are experts in diagnosing and treating all types of herniated disks. Our initial exam for a suspected herniated disk generally includes:
- Taking your medical history to understand when your pain began, and when the pain feels most severe. Our physicians will ask other questions to get a full picture of your health, including whether you have other medical problems and if you take any medications.
- Physical exam performed by our orthopedists to determine where your back is most sensitive by examining it and by asking you to move and bend in different directions.
- Imaging tests to examine the bones and joints themselves using state-of-the-art imaging techniques, including:
- X-ray, which can help determine if your bones are aging;
- CT scan, which combines X-ray technology with computers to provide a very detailed picture of the spine;
- MRI, which uses powerful magnets and computer technology to create a picture of your muscles, tissues, nerves, and disks;
- Nerve test, which can show how well your nerves are functioning, and indicate exactly where you have a herniated disk; and
- Discograms, which involves disk injections to confirm which disks are causing pain.
Non-Surgical Herniated Disk Treatment
Before considering surgical options, we carefully evaluate each patient to determine if non-surgical approaches can provide effective pain relief.
Many people with herniated disk pain respond well to a combination of rest, prescription or over-the-counter anti-inflammatory or pain medications, and physical therapy, massage, and strengthening exercises. MedStar Montgomery offers a range of other non-surgical options to manage herniated disk conditions:
- Epidural steroid injections which reduce pain that starts in the spine and radiates to an arm or leg. Epidural steroids such as cortisone are injected into the spinal canal to decrease inflammation or compression of a nerve and the associated nerve pain. These injections may be recommended for patients with herniated, bulging, or degenerated disks.
- Epidural lyses of adhesion, injections of a medication into damaged nerve roots to help dissolve scar tissue. These injections can help relieve chronic low back pain and provide relief to patients who have had previous surgeries for herniated disks.
- Nerve root blocks, injections to relieve pain where nerves branch off from the spinal cord. Nerve root blocks can be very effective in managing the pain associated with a herniated disk.
- Intradiscal electrothermal therapy, the insertion of a heated needle inserted into a painful disk to destroy the local pain receptors. This procedure can help patients with chronic disk pain who wish to avoid surgery, or for patients whose previous surgery has been unsuccessful.
Herniated Disk Surgery
If non-surgical treatment does not relieve your pain, you may need surgery. MedStar Montgomery orthopedic surgeons will help you weigh the risks and benefits of all options – both non-surgical and surgical – so you can choose a treatment plan that will be most appropriate and effective for you.
If surgery is required, our orthopedic surgeons at MedStar Montgomery have extensive training in the most advanced and innovative surgical procedures to treat complications of herniated disks, including:
- Laminectomy and Diskectomy; a minimally-invasive procedure that performed through an incision down the center of the back over the area of the herniated disk. The surgeon cuts a small opening through the lamina bone on the back of the vertebra to access the inside of the spinal canal (laminectomy). The surgeon then removes as much of the problem disk as possible, easing compression of the spinal cord and/or pinched nerves (diskectomy). This procedure also prevents remaining disk material from herniating in the future. In a minimally invasive diskectomy, surgeons use special retractors and a microscope or endoscope to perform the removal of the herniated disk. This allows our surgeons to make smaller incisions that lead to a faster recovery. These surgeries are completed under general anesthesia, typically take less than an hour and patients are able to go home several hours later.
- Anterior Cervical Diskectomy and Fusion (ACDF); a surgical procedure where the affected disk is removed through the front of the neck (anterior approach) in order to reduce compression of the spinal cord or pinched nerves and relieve pain. This procedure is combined with a fusion surgery to stabilize the neck.
MedStar Montgomery’s expert team of orthopedic surgeons works to develop an individualized treatment plan for each patient that includes pinpointing the location of your herniated disk and recommending the most appropriate non-surgical or surgical interventions to relieve your pain and get you back to the activities you enjoy.