The vertebral column, also known as the spinal column or simply spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum's five bones and the coccyx's four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulposus).These cartilaginous intervertebral discs, which act as "shock-absorbers," help distribute weight, and keep vertebrae oriented in the correct spacing.
A herniated disc occurs when part of the center pushes through the outer edge of the disk and back toward the spinal canal. This herniation puts pressure on the spinal nerves, resulting in pain or numbness in one or both arms or legs, and sometimes weakness depending on the location of the herniated disk: neck or lower back respectively.
Herniated disc may be associated with the following signs and symptoms:
- Numbness or tingling in the arm, leg, or buttock
- A burning pain in the shoulder, neck, or arms
- Occasional weakness or loss of bladder and bowel control
If the individual feels weakness in the arms or legs or a loss of bladder and bowel control, it’s advised to consult a physician immediately.
Herniated disc is diagnosed with a combination of physical examination and imaging studies. After discussing the individual's symptoms, the physician will examine the neck, arms and legs for the symptoms mentioned above. The physician may then order an X-ray or MRI to identify the cause of pain and confirm diagnosis of herniated disc.
Activity Modification - Pain is often aggravated when making certain movements, therefore changing patterns to avoid activities that worsen the symptoms may be helpful.
Medication - Over-the-counter pain relief medication such as acetaminophen as well as non-steroidal anti-inflammatory medicines (NSAIDs) can significantly reduce pain and swelling. If these are deemed insufficient by the physician, they might prescribe stronger medication to relive pain and reduce inflammation. The physician may prescribe nerve pain medication to ease the symptoms of herniated discs.
Epidural Steroid Injections - Injecting the area around the spinal nerves with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain. This is done using real-time x-ray imaging (fluoroscopy). Oral or IV sedation may be offered to keep the patient comfortable during this procedure.
Physical Therapy - Physical Therapists will often demonstrate specific positions and movements that reduce the pain of a herniated disc.
Surgery - Operative treatment is typically reserved for individuals who have spinal stenosis (or narrowing) that is interfering with their day-to-day activities. Minimally invasive microscopically assisted lumbar decompression at one level can be performed as an outpatient procedure for most patients. Operative microscopy allows a minimally invasive approach which allows you to go home on the same day and recovery occurs, in general, by 6 weeks.
Recovery will vary based on the severity of the herniated disc as well as the chosen treatment approach. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of damage, and desired level of activity they would like to return to. Based on the treatment approach, the physician will discuss the appropriate recovery timeline.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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