A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall (annulus). The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if neck and/or arm pain is going to resolve it will do so in about 6 weeks.
Symptoms vary greatly depending on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, you may experience a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.
Lumbar spine (lower back): Sciatica frequently results from a herniated disc in the lower back. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Along with leg pain, you may experience low back pain. Recommend using radiculopathy rather than sciatica since all leg pain isn’t “sciatica”)
Cervical spine (neck): Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck.
Diagnosis is made by a neurosurgeon based on your history, symptoms, a physical examination and results of tests, including the following:
- X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc.
- Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads X-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.
- Magnetic resonance imaging (MRI): A diagnostic test that produces 3-D images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots and surrounding areas, as well as enlargement, degeneration, and tumors.
- Myleogram: An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.
- Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury or whether there is another site of nerve compression.
Anterior cervical discectomy & fusion (ACDF): The surgeon makes a small incision in the front of your neck. The neck muscles, vessels and nerves are moved aside to expose the bony vertebra and disc. Using special instruments, the portion of the ruptured disc that is pressing on the nerve is removed. After removing the herniated disc, the disc space may be filled with a bone graft or cage to create a fusion. Fusion is the process of joining together bone.
Artificial disc replacement: can be performed during anterior discectomy instead of a fusion. Similar to knee replacement, the artificial disc is inserted into the damaged joint space and preserves motion, whereas fusion eliminates motion.
Minimally invasive microendoscopic discectomy: The surgeon makes a tiny incision in the back of the neck. Small tubes called dilators are used with increasing diameter to enlarge a tunnel to the vertebra. A portion of the bone is removed to expose the nerve root and disc.
Posterior cervical discectomy: The surgeon makes a 1-2 inch incision in the back of your neck. To reach the damaged disc, the spinal muscles are dissected and moved aside to expose the bony vertebra. A portion of the bone is removed to expose the nerve root and disc space.
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