The spinal column consists of bony elements referred to as the vertebra and the discs which reside between each vertebra. The disc can be compared to an inflated tire which acts as a cushion between each segment. During childhood the Disc is highly hydrated and performs its function very efficiently. As we grow older the disc looses water content and looses height and ability to resist the forces on the spine. If the disc is cut into sections, we can see the internal architecture of the disc. The inner section of the disc is referred to as the Nucleus Polposus, and is a gelatinous material. The Nucleus Polposus is surrounded by a tick tissue called the Annulus. As we continue aging, the annulus also looses its strength and may develop fissures which may allow the inner Nucleus Polposus of the disc to protrude through these fissures.

As the degenerated disc looses its strength, any mechanical insult may cause the Nucleus Polposus to herniate and place pressure on a nerve root that passes in the area. Not only the mechanical pressure produces symptoms, but research studies have clearly shown that chemicals released from the herniated disc produce inflammation and nerve dysfunction. It is for this reason that anti-inflammatory medications reduce the symptoms of a herniated disc. These medications do not change the mechanical pressure but counteract the chemicals released in the area.

Below is a MRI image of a patient with a herniated disc. The picture on the right is colored for description purposes and better understanding. The blue colored structure is the disc space and the front body of the vertebrae. The orange colored section represents the herniated disc material. It completely obscures the nerve root, making it impossible to visualize. The nerve root on the other side of the body is not affected by this herniation (labeled in red) and is in its normal position.

Since the neck (cervical spine) and the low back (lumbar spine) are the most mobile sections of the spine, these areas are most vulnerable to disc herniation. In the lumbar spine L5-S1 and L4-L5 levels are very common areas for disc herniation. In the Cervical spine C5-6 and C6-7 are common areas as well. Most patients presenting with this problem are 30-45 years of age. The most common complaint is pain radiating to the arm or leg. This may be accompanied with or without back pain. Occasionally, back pain dominate the symptoms which indicates a tear in the outer covering of the disc followed by leg pain which represents herniation of the disc material (nucleus polposus).

Most patients present with pain and numbness. However, some patients may present with gross weakness of to their feet. Rarely, control of bowel and bladder function is lost. This requires prompt surgical decompression in an attempt to preserve these vital function. Most patients however, will suffer only from pain, numbness, and only mild weakness and will benefit from conservative treatment without a surgical procedure. The majority of patients will improve their symptoms within 6-8 weeks. To expedite this healing process, conservative measures are provided to the patient. These include: Anti-inflammatory medications, Steroidal anti-inflammatory medication, physical therapy, epidural steroid injections, or selective nerve root block. Regarding modalities such as chiropractic and accupuncture please refert to the appropriate sections within this web site.

There are several situations that a surgical procedure is considered. Almost all patients will undergo a trial of conservative (non-operative) treatment. From research studies we predict that most patient will resolve their symptoms within an 8 week period. However, patients that fail to improve may choose to have a discectomy. There are several techniques used to perform discectomy such as Micro-Endoscopic Discetomy (MED), Micro-Discectomy, or the traditional laminectomy and discectomy. Our center specializes in minimally invasive surgery and we prefer the Micro-Endoscopic Discectomy procedure over the traditional open procedures. Other situations which need surgical attention is inability to cope with the dysfunction and pain. In these cases, patients can not get relief from conservative modalities and choose to have the procedure earlier in the disease course. In situations of severe weakness we offer the procedures earlier in an attempt to preserve motor function. This issue is controversial but many surgeons will recommend earlier surgery with profound weakness. Surgical results are excellent with 97% chance of recovery. In most cases only a small portion of the disc is excise (only 5-7%). The area is usually replaced and filled with scar tissue. There is a low but definet chance of recurrence but most patients will benefit from pain relief.

After discectomy operations, many patients can be released home the same day. Depending on the type of operation, and the postoperative pain, the decision to stay in the hospital or be discharged home can me made with the guidance of your surgeon. Gradually as the operative site heals, the pain will also improve, leading, hopefully, to a productive, enjoyable life style.

More information is availabe in this web site regarding each type of procedure, including the risks and benefits. As with any procedrue, the risks, benefits, and alternative treatment options should be expolored to arrive at a treatment program that will benefit each patient.