Herniated Discs

In between each vertebrae is a disc. These discs act as a shock absorbers that handle the normal loading of the spine with activities of living. The outer casing is a tough material called the “Annulus Fibrosis” which houses the gel like incompressible material inside called the “Nucleus Pulposus”. Picture a jelly donut as an easy analogy. If the jelly is compressed to one side of the donut, but does not exit the dough, you have a disc bulge. If the jelly squirts out of the dough, you have a true herniation. When the nucleus pulposus protrudes through the annulus fibrosis and causes pressure on the spinal cord or exiting nerve roots, you are left with pain caused by a herniated disc.

Etiology
There are different reasons that the annulus fibrosus cracks and opens allowing the inner material to migrate.

Disc degeneration: Occurs when the disc weakens secondary to chemical changes caused mainly by aging.

Personal lifestyle: Some things such as poor diet/nutrition, smoking or lack of exercise can contribute to degeneration.

Natural aging: The normal aging process causes the disc material to eventually dry out and lose it’s resiliency and strength.

Habitus: Increased physical activities can lead to premature degeneration. Poor posture and poor lifting mechanics can contribute to accelerated and abnormal wear.

Treatment
Non Surgical: In the first one to two days following onset of your pain, activity modification and cold packs may significantly help reduce your symptoms. Avoid skin injury by direct application of ice to bare skin.

Anti inflammatory or corticisteroid medication may help reduce edema causing pressure on nerve structures, thus relieving pain.

Physical therapy modalities may help reduce muscle spasm and edema, while increasing mobility and endurance.

Activity modification is strongly recommended to avoid reinjury and prolong recovery.

Epidural Steroid injection attempts to decrease inflammatory effects on neural structures if pain is severe or other conservative measures fail.

Surgical: If weakness develops or pain persists/worsens despite conservative treatment, micro discectomy will be discussed with you by your surgeon. This technique allows removal of the disc fragment causing pressure on neural structures by the use of a microscope and minor incision. Sometimes, a larger incision may be necessary along with removing a portion of the overlying bone structure to gain better