The spine is made up of a stack of vertebrae separated by intervertebral discs. The inner part of these discs, called the nucleus pulposus, are mostly made up of water and lose hydration during the course of each day and also over the course of time as we get older. The outer ring of the disc is called the annulus fibrosis. Annulus, meaning “ring”, surrounds the inner nucleus and serves to keep the inner disc material in place.
A herniated disc is one in which the disc bulges outwards. This can cause the disc to change shape and leads to the leakage of inflammatory factors that cause pain and irritate the nearby nerves. The pain from a herniated disc can range from mild to severe, unbearable pain.
Symptoms of a herniated disc:
- Pain worse with movement
- Pain, numbness and tingling on one side of the body
- Muscle spasms
- Stiffness
- Weakness
- Pain radiating down arms or legs
Sciatica can cause a burning, tingling, pins and needles like sensation that can travel from the low back and into the buttock or leg.
A herniated disc in the neck can cause either headaches going up the back of the scalp or radiating pain that shoots down the arm, sometimes into the hand and fingers.
Causes of herniated discs:
- Sedentary lifestyle
- Obesity
- Smoking
- Excess force to the spine (fall, car accident)
- Lifting an object improperly or twisting the back
- Repetitive stress on the back
Diagnosis of a herniated disc
Diagnosing a herniated disc is relatively simple. Most diagnoses are made by a combination of a thorough medical history and physical exam. This can be confirmed by a CT or MRI scan.
Treatment options for herniated discs
Treating a herniated disc does NOT always require surgery! In most cases, the pain from a herniated disc will resolve on its own over the course of weeks to months. Surgery can cause more pain as well as the potential to cause scar tissue to build up around the spinal cord, which is irreversible and leads to worse pain in the long term. There are many conservative treatments that are recommended first. Those include a combination of the following:
- Relative rest
- Medications to reduce pain, inflammation, and to relax the muscles
- Physical therapy
- Home exercises
- Back braces to support the spine
Interventional Pain Management Treatments
Although some cases of herniated discs resolve spontaneously, many do not. Many patients do not want to wait weeks or months for the pain to subside. The disc will never “un-herniate” or “go back in” to normal, so there is a potential for pain to return at any time. This is the point where interventional pain treatments come in. If pain persists beyond 6 weeks, it will likely continue if there is no intervention.
What is a LESI?
A LESI (lumbar epidural steroid injection) is a tried and true, safe and effective procedure for low back pain. This procedure involves numbing of the skin followed by placement of a small amount of an anti-inflammatory medication in the epidural space. This treatment can dramatically improve swelling, inflammation and pain in the low back.
What is a TESI?
A transforaminal epidural steroid injection is similar to a LESI (lumbar epidural steroid injection), however this procedure directs the medication directly near the nerve fibers that make up the sciatic nerve. The end result is that the medication is placed closer to the affected area.
Surgery
Some herniated discs persist even after all less invasive methods have been tried. In cases like these, surgery may be the only option.