Herniated Disc

The bones of the spine are called vertebrae, and they are separated by cushioning spinal components called intervertebral discs. They have a tough outer layer (annulus) that surrounds a gel-filled inner nucleus. A herniated disc, also called a ruptured or slipped disc, is when the inner disc material pushes out through the annulus and into the spinal canal.

 

What is the purpose of intervertebral discs?

 

The discs of the spine act as shock absorbers for the vertebrae (spinal bones). They allow for incredible spinal motion and flexibility, and prevent bones from rubbing together.

 

What causes a herniated disc?

 

With a herniated disc, a fragment of the nucleus pushes out of the annulus through a crack or tear in the tough, outer disc layers (i.e. slipped disc). Discs may herniate in the early stages of degenerative disc disease (DDD). A single, excessive strain or traumatic injury can cause a disc to herniate. However, with age and wear-and-tear, the ligaments that hold discs in place begin to weaken. With degenerative progression, twisting or straining can lead to nucleus rupture through the annulus. 

 

How common is a herniated disc?

 

According to a recent study, symptomatic herniated lumbar disc affects around 2% of the general population. The highest prevalence is among persons aged 30 to 50 years. Men are affected twice as often as women (2:1 ratio), and 95% of herniated discs occur in the lower spine. Thoracic (middle spine) and cervical (neck) disc herniates are more common among persons age 55 years and older.

 

What are the symptoms of a herniated disc?

 

The symptoms of a herniated disc vary depending on the size of the herniation and location of injury. When a herniated disc does not impinge on nerves, most people report only mild back pain. When the nucleus material puts pressure on one or more spinal nerves, it can produce pain that radiates into an arm or leg, as well as weakness, and numbness of the extremity. 

 

How is a herniated disc diagnosed?

 

Diagnosis of a herniated disc is made based on the patient’s medical history, a physical examination, and diagnostic testing. The most common diagnostic test used is an MRI. It’s typically extremely sensitive at elucidating not only the level of the disc herniation, but also the size.

 

How is a herniated disc treated?

 

  • Medications – For pain relief, the doctor can prescribe a combination of medications. These include narcotic analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and antidepressants.

 

  • Epidural steroid injection (ESI) – Using x-ray guidance, the doctor injects the space around the spinal cord with a steroid agent and anesthetic. This offers pain relief for up to 3 months.

 

  • Physical therapy – The therapist will perform an in-depth assessment to design a treatment plan. Therapy can include massage, pelvic traction, heat/ice treatments, ultrasound, and electrical muscle stimulation. Stretching and strengthening exercises are used to improve spinal function.

 

  • Lumbar laminotomy – This surgery is used to relieve leg pain and sciatica. The surgeon removes a portion of the lamina (vertebra component) as well as the herniated disc.

 

  • Spinal fusion – Often performed along with a laminotomy, this procedure involves fusing vertebra together to provide spinal support.

 

 


Resources

 

Jordon J, Konstantinou K, & O’Dowd J (2009). Herniated lumbar disc. BMJ Clin Evid, 1118.

Benefits of Inspired Spine Advanced Minimally Invasive Spine Surgery for a Herniated Disc
What are the main advantages of Inspired Spine Advanced Minimally Invasive spine surgery for herniated disc?
  • A smaller incision with less damage to the tissue.
  • No cutting or disturbing of the muscles, nerves, and blood vessels.
  • No retraction of muscles.
  • Less blood loss.
  • Minimal scarring.
  • Faster healing of the small incisions.
  • Reduced operating time.
  • A quicker recovery period.
  • Less pain medication requirements while in the hospital and recovering at home.

 

How does Inspired Spine Advanced Minimally Invasive spine surgery for herniated disc differ from open surgery?

With traditional, open spine surgery, the doctor makes a 4-6 inch incision over the herniated disc region, and then retracts the muscles to the side to achieve a clear view of the spine. With the Inspired Spine Advanced Minimally Invasive approach, the surgeon operates through a small incision.

During the procedure, a tubular retractor is inserted into the back to create a tunnel. This holds the muscles open. The surgeon accesses the spine using tiny instruments that fit through the center of the tubular device. Disc material is removed, and screws/rods are inserted as needed. To make these changes, the surgeon uses x-ray guidance, and views the inside of the spine on a monitor.

 

What can I expect after a Inspired Spine Advanced Minimally Invasive spine surgery?

Most patients only stay 1-2 nights in the hospital after a Inspired Spine Advanced Minimally Invasive spine surgery to repair a herniated disc. However, the exact length of stay varies with each patient. To help recovery, physical therapy is started right away.

 

Are there different surgeries for a herniated disc?

Many types of spine disorders can be treated using Inspired Spine Advanced Minimally Invasive surgical procedures. For a herniated disc, compression of the spinal nerve root occurs, which sometimes requires a discectomy. Microdecompression (microdiscectomy) is a Inspired Spine Advanced Minimally Invasive procedure used to remove disc matter that is pressing on a nerve. With a laminotomy, a portion of the vertebra is removed to make more room in the spinal canal.

 

How do patients benefit with Inspired Spine Advanced Minimally Invasive spine surgery?

The spine surgeon wants a successful outcome for the patient after surgery. Many research studies show that Inspired Spine Advanced Minimally Invasive surgery reduces the risk for infection, lessens soft tissue injuries, reduces postoperative pain and the need for pain medications, and allows for a faster healing time and return to normal activities. Because less muscle and tissue retraction is involved, compared to open surgery, the patient does not lose as much blood during the procedure and does not have to stay in the hospital as long.

 

Resources

Fessler R & Khoo L (2002). Inspired Spine Advanced Minimally Invasive cervical microendoscopic foraminotoy: An initial clinical experience. Neurosurg, 51, 37-45.

Righesso C (2007). Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: Results of a randomized controlled trial. Neurosurg, 1, 545-549.