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Herniated Disc

A common cause of neck & back pain

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What is a Spinal or Intervertebral disc?

It is a rubbery cushion (disc) between individual bones of the spine (vertebrae). A spinal disc is somewhat like a jelly donut with a soft center (nucleus pulposus) within a hard exterior (annulus fibrosus).


What is Spinal Disc Herniation?

 
 Herniated Disc
 

Spinal disc herniation occurs when some of the softer "jelly" present in the center of the disc pushes out through a crack in the tough exterior. A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. Herniated disc is also referred to as a slipped disc or a ruptured disc.


What are the risk factors associated with spinal disc herniation?

Most people are unable to pinpoint the exact cause of disc herniation. Risk factors associated with disc herniation include:

  • Aging 
  • Injury or traumatic events
  • Motor Vehicle Accident
  • Obesity
  • Lifting heavy objects

What are the symptoms of Herniated Disc Disease?

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The following symptoms are commonly seen in Herniated Disc Disease

- Lower back or neck pain

- Pain or weakness in various parts of the arms, shoulders, leg and buttocks.

- "Pins and needles" sensation, or tingling in the arms, shoulders, leg and buttocks.


How do you diagnose Herniated Disc Disease?

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Medical history and physical examination can usually identify any serious conditions that may be causing the pain. Dr. Goswami will ask about the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. Along with the history, a thorough neurologic examination will be conducted to determine the cause of pain. 

Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including herniated disc or spinal stenosis.

Commonly used diagnostic tests include:

  • X-ray

  • Computerized tomography (CT)

  • Magnetic resonance imaging (MRI) 

  • Myelograms 

  • Discography

  • Electromyography (EMG)/ Nerve Conduction Studies (NCS) 

  • Evoked Potential (EP) studies


How do you treat Herniated Disc Disease?

The goal of our treatment is functional restoration. While eliminating chronic back pain is extremely hard, our functional restoration program seeks to return patients to levels of activity that they were able to perform prior to suffering from back pain. Usually a combination of conservative therapy, physical therapy and interventional therapy is needed. 

Conservative treatment 

  • Applying heat or ice to the painful area
  • Taking over the counter pain relievers such as Tylenol or Ibuprofen.  

Physical Therapy/ Muscle strengthening regimen

We encourage our patients to begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain. Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combinations with other interventions.

Medical Management

We prescribe different medication for pain relief. Certain medication such as anticonvulsants and antidepressants are known to benefit patients suffering from herniated disc disease. In some patients we also prescribe opioids such as codeine, oxycodone, hydrocodone, and morphine. The use of opioids is heavily regulated by Drug Enforcement Agency (DEA). In our practice all patients who are being treated with opioids are required to sign an Opioid Agreement and periodically undergo urine and blood testing.

Minimally Invasive Treatment

Some of the common minimally invasive treatment options include:

Epidural Steroid Injection

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A small amount of corticosteroid is injected into the epidural space around the spinal cord and spinal nerves. The anti-inflammatory effects of the corticosteroid is responsible for providing pain relief. 

Endoscopic Discectomy

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A small metal tube, the size of a pencil, is inserted into the herniated disc space under x-ray and camera guidance and the fragment of the disc pinching the nerve is removed. You might benefit from discectomy if your presentation includes: pain, numbness or weakness in arms or legs.


Will I need open surgery?

Open surgery is usually reserved for very few patients with pain from structural anatomical problems that have not responded to medical or interventional therapy.


When do I need to see a doctor?

You should seek immediate medical attention if you experience worsening symptoms, such as:  

  • Inability to perform activities of daily living 
  • Increasing back or neck pain 
  • Increasing weakness or numbness of arms or legs
  • Radiating pain
  • Back or neck pain traveling down your arm or leg
  • Bowel or bladder dysfunction