There are many potential causes for back pain, but one of the more frequent diagnoses is a herniated disc. The spine is made up of a series of connected bones called “vertebrae.” The disc is a combination of strong connective tissues that hold one vertebra to the next, and acts as a cushion between the vertebrae. The disc is made of a tough outer layer called the “annulus fibrosus” and a gel-like center called the “nucleus pulposus.” As you get older, the center of the disc may start to lose water content, making the disc less effective as a cushion. This may cause a displacement of the disc’s center (called a herniated or ruptured disc) through a crack in the outer layer. Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist. A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg called “sciatica.”
Eighty to NINETY percent of patients with an acute lumbar disc herniation will improve without surgery.
Non-surgical treatments may include a short period of rest, anti-inflammatory medications (to reduce the swelling), analgesic drugs to control the pain, physical therapy, exercise or epidural steroid injection therapy. The goals of nonsurgical treatment are to reduce the irritation of the nerve and disc and to improve the physical condition of the patient to protect the spine and increase overall function.
Medication and Pain Management
Epidural injections or “blocks” may be recommended if you have severe leg pain. These are injections of corticosteroid into the epidural space (the area around the spinal nerves). The purpose of the injection is to reduce inflammation of the nerve and the disc.
Surgical treatment usually entails a common outpatient procedure called a “microdiscectomy” in which part of the herniated disc is removed. Under anesthesia, a small incision is made in the skin over the herniated disc and the herniated disc and any loose pieces are removed until they are no longer pressing on the nerve. Any bone spurs are also taken out to make sure that the nerve is free of pressure. Once home, patients are instructed to avoid excessive lifting and bending forward for the first four weeks. Most patients can return to work within a week.
Eighty to 90 percent of patients with an acute lumbar disc herniation will improve without surgery. However, if pain keeps you from your normal lifestyle after completing non-surgical treatment, your health care provider might recommend surgery. Surgery results in a 90 percent success rate for relief of leg pain, but is less effective in relieving back pain.
If you are suffering from back pain, a spine specialist may be able to recommend the treatment that is best for you.
Scott Stanley, MD is a fellowship trained spine surgeon on staff at Parker Adventist Hospital. For more information visit www.parkerhospital.org.