Lumbar and cervical disc herniation
Lumbar Disc Herniation :: Cervical Disc Herniation
Lumbar Disc Herniation
The lower part of the spine (lumbar spine) is made up of five vertebrae, each separated by an intervertebral disc which acts as a shock absorber for the spine. The normal intervertebral disc is composed of a nucleus pulposus, at the centre, surrounded by a fibrous ring known as annulus fibrosis. Lumbar disc herniation is a condition in which the inner gelatinous substance of the disc escapes through a tear in the outer fibrous ring causing a compression of the spinal cord or the surrounding nerves, resulting in back pain. Lumbar disc herniation is also known as slipped or ruptured disc. It is one of the most common causes of low back pain, as well as leg pain.
Traumatic injury, aging, repetitive movements, wear and tear, smoking, poor diet, and being overweight may affect the structure and functioning of the disc.
Symptoms
The most frequent symptom of a lumbar disc herniation is back pain that radiates to the buttocks and legs. The pain can be mild or severe and is usually aggravated by movement. Other symptoms such as difficulty in moving your lower back, numbness, tingling sensation, muscle weakness, and rarely bladder or bowel problems may also occur.
Diagnosis
Precise diagnosis of lumbar disc herniation is important to devise an effective and successful treatment plan. The diagnosis of a lumbar disc herniation is based on your symptoms, medical history, along with a physical and neurological examination. Your sensations, reflexes, and muscle strength will be evaluated by your doctor. Imaging tests such as X-rays, MRI or CT scan may be recommended to confirm the diagnosis of a herniated disc. Simple X-rays will help locate the collapsed disc space. A CT or MRI scan provides detailed images of the discs, nerve roots, and other structures of the spine.
Treatment
Treatment of a lumbar herniated disc comprises of conservative and surgical treatment options. Non-surgical treatment of lower disc herniation usually helps relieve pain and the associated symptoms. Some of the common nonsurgical measures include activity modifications, anti-inflammatory and pain medications, muscle relaxants, spinal injections, braces, physical therapy, and acupuncture. To increase the likelihood of a successful treatment outcome, you doctor may advise a combination of two or more treatment modalities.
Surgery is not always indicated for patients with lumbar disc herniation. Your doctor may recommend surgery if the lumbar disc herniation is associated with spinal instability or neurological dysfunction or in cases of persistent pain that fail to respond to conservative treatment.
Usually a minimally invasive surgical approach is used to remove the protruding portion of the disc. A lumbar interbody fusion, which can be performed from the front, back or side of the spine, is the most common surgical procedure for the management of lumbar disc herniation. Spinal stabilization and fusion may be performed to alleviate the pain and stabilize the spine.
Your surgeon will discuss the different techniques available for the management of lumbar disc herniation, along with the pros and cons of each technique and will recommend the most appropriate procedure for you.
Cervical Disc Herniation
The normal intervertebral disc is composed of a nucleus pulposus, at the centre, surrounded by a fibrous ring known as annulus fibrosus. Cervical disc herniation is a condition in which the inner gelatinous substance of the disc escapes through a tear in the outer, fibrous ring causing a compression of the spinal cord or the surrounding nerves, resulting in neck or arm pain. Herniated disc is also known as a bulging disc, ruptured disc or slipped disc.
Causes
A cervical herniated disc may be caused by wear and tear of the disc due to the normal aging process or an injury to the cervical spine.
Symptoms
The predominant symptom of a cervical disc herniation is pain. The pain can range from mild to severe and is usually aggravated by movement. Other symptoms include problems with gait and balance, numbness, tingling and weakness radiating down your shoulder, arm, and hand, and rarely bladder and bowel problems.
Diagnosis
Your doctor will usually diagnose a herniated disc from your history of symptoms and a physical examination. Your doctor may also perform a neurological examination to evaluate your sensations, reflexes, and the strength of the muscles. Other imaging tests such as X-rays, MRI or CT scan may be ordered to confirm the diagnosis of a herniated disc. X-rays of the cervical spine may be taken to locate the collapsed disc space. A CT and MRI scan provides better visualization of the anatomy of the intervertebral discs and spinal cord.
Treatment
Treatment comprises of conservative and surgical treatment options. The conservative treatment options such as anti-inflammatory and pain medications, muscle relaxants, physical therapy, spinal injections, certain types of braces, and acupuncture can help reduce pain and associated symptoms. To increase the success of the treatment, your doctor may combine two or more treatment modalities.
Some people with cervical herniated disc may require surgery. Surgery is indicated for patients with unstable spine or neurological dysfunction and patients with persistent pain which does not improve with non-surgical treatment. Anterior cervical discectomy is a common surgical procedure for the management of cervical disc herniation. Anterior cervical discectomy and fusion (ACDF) is a type of minimally invasive surgical procedure performed through the front of the neck to remove a herniated disc from the cervical spine region. Sometimes, spinal stabilization and fusion may be required to reduce the pain and stabilize the spine.
Your surgeon will discuss surgical options and recommend the appropriate treatment plan for you.
