22 Aug Overview of Disc Herniation from a Chicago Pain Center
An intervertebral disc is the soft gel-like cushion between the vertebrae that acts as a spacer and shock absorber, and allow the wide range of motion that the spine is capable of. Sometimes these discs become damaged from injury of just age related degeneration and become what is referred to as a bulging disc. This condition is when the disc protrudes beyond its’ normal range and may come into contact with surrounding nerves and cause pain.
A herniated disc however is a far more advanced condition in which the harder outer layer (annulus fibrosus) becomes torn and the soft inner core (nucleus pulposus) protrudes through the outer wall. The protruding material may come into contact with surrounding nerves or the spinal cord itself and create a very painful condition.
As much as 90% of the population will experience some type of back pain, many of these from herniated discs. The susceptibility of a person to a herniated disc decreases after about 50 years of age due to less fluid present in the nucleus. Persons most susceptible to herniated discs are those with strenuous jobs, sustain spinal injury, or are overweight.
What are the symptoms that are associated with herniated discs?
Some persons may show no symptoms of a herniated disc while others may experience pain, numbness and tingling of extremities, and muscle weakness. This pain may increase with certain activities or from something as simple as a cough or sneeze. Sometimes if a nerve has become impinged (pinched) the person may lose some dexterity and motor ability, may drop objects, and have difficulty walking.
How is a herniated disc diagnosed?
There are several methods of diagnosis for herniated discs. X-rays are not helpful as they do not show the soft tissues of the spine. Physical examination and history are actually extremely helpful for establishing the diagnosis, with an MRI helping confirm it.
MRI (magnetic resonance imaging) helps to obtain clear images of the soft tissue structures surrounding the spinal column and can precisely locate the herniated disc and any nerves being contacted by the protruding tissue. A myelogram is a method where dye is injected into the spinal fluid to act as contrast during x-rays to help locate the herniated disc. The myelogram is really only indicated these days when an individual cannot undergo an MRI due to hardware in place or other concern.
What are the treatments available for herniated discs?
Some patients’ can get relief from simple OTC (over the counter) medications like acetaminophen (Tylenol), ibuprofen (Motrin), or naproxen sodium (Aleve). Others may need something stronger like prescription nerve pain medications like Neurontin or opioid analgesics like hydrocodone (Vicodan), or oxycodone (Percocet).
Spinal decompression therapy involves intermitten spinal traction and has been shown to be over 80% effective for the relief of disc herniation pain. Other patients may find the most relief from nerve block injections where a mixture of local anesthetic and corticosteroids are used to numb the nerve. This is called an epidural injection.
What are expectations when a patient receives treatment?
Most patients will experience some level of relief from one or more of the available treatments; however, individual results cannot be anticipated as people respond differently to the medications. However the majority of patients that receive the nerve block injections experience a significant reduction in pain levels.
Over 75% of individuals obtain relief from a few days to a few months. The procedures are typically repeated 3 times over a period of six weeks as necessary and then may be repeated months later if necessary.
How is the procedure performed?
A nerve block injection is a minimally invasive outpatient procedure that generally takes about thirty minutes to perform. The patient is placed on an x-ray compatible table, face down, and the vital signs are monitored. The patient may choose to be sedated or simply receive numbing medicine.
The Chicago pain managementdoctor uses imaging guidance with ultrasound or a fluoroscope, a type of real time x-ray machine, to precisely place a needle and then injects contrast dye to confirm proper placement. The mixture of medications is then slowly injected. After the injection the patient is moved to an adjacent room for observation against allergic reaction to the medications used.
How long do the benefit from the injections last?
Usually the patient will experience immediate relief from the local anesthetic; this wears off in about 24 hours. The steroid medication may take up to 48 hours to become effective but then may last for several days to several months with the first treatment. Subsequent treatments may begin to provide longer lasting results often up to several months at a time.
What risk or side effects are possible?
Risks and side effects are minimal and may include minimal bruising, swelling, and bleeding at the injection site. Rarely a patient will have a reaction to the medications used.
The chance of infection is less than 1%. At times, the steroid may cause a transient increase in blood sugars.
How successful are they for the relief of pain?
These injections are very effective in relieving pain for most patients. Over half who receive them report a better than 75% decrease in pain levels. A landmark JAMA study years ago showed nonoperative treatment of disc hernation with sciatica was just as successfully as surgery at the one year time frame.