What You Need to Know About a Herniated Disk
Listen to Jacob Smith on our podcast Memorial Health Radio in the new episode titled Herniated Disks.
Transcription
Melanie Cole (Host): According to the American Academy of Orthopedic Surgeons, between 60 and 80% of people will experience low back pain at some point in their lives. A high percentage of people will have low back and leg pain that could be caused by a herniated disc. My guest today is Dr. Jacob Smith. He’s an orthopedic surgeon with Memorial Health System. Welcome to the show, Dr. Smith. People have heard the word herniated disc — slipped, ruptured, bulging – there’s all these things that go along with discs. What is a herniated disc?
Dr. Jacob Smith (Guest): A herniated disc is when the inside portion of a disc has actually herniated or extruded from the outer rings of that disc, and when it does that, it can put pressure on some of the nerve roots that course in your spinal canal.
Melanie: What might be some of the causes, and are certain people more at risk for herniated disc than others?
Dr. Smith: Causes of a herniated disc could be a lifting injury or a motor vehicle accident. There are certain individuals who, we think, are more prone to herniated discs or degenerative disc problems and those are usually seen in people who smoke.
Melanie: Is being overweight – does that put you at risk of getting a herniated disc? And plus, there’s a lot of weight-lifters – you said improper lifting could cause it – when people are doing things that they know to be good for them, like weight training, could that also cause something like this if they do it improperly?
Dr. Smith: Improperly lifting could cause a herniated disc. Also, the patient being overweight could make them susceptible to disc problems in their low back.
Melanie: So how would they know, Dr. Smith? Would they feel it – because you get some other injuries and you actually feel them happening – would you feel a disc as it herniates if you lift improperly or it’s something that happens over time? What are some of the symptoms you might feel?
Dr. Smith: Usually, some of the first symptoms with a herniated disc are low back pain, and the patient may feel as if they simply strained their back or I threw my back out, and they’ll develop some secondary muscular pain and possibly muscle spasms in their low back. And then over the coming weeks, sometimes they will develop pain down their leg, or sciatica pain.
Melanie: That sciatica pain can be some of the worst pain that people experience. When they start to feel that, what is sciatica pain? Explain that a little because sometimes people feel it in their groin, or down the side of their leg, or even in the arch of their foot.
Dr. Smith: Sciatica pain usually starts in the low back or buttock area and will radiate down the back of your thigh, and sometimes into your lower leg and onto the top, or outside, or bottom of your foot, and sometimes this can be accompanied by numbness and tingling.
Melanie: Which can be pretty scary, so what would you advise people to do if they do start to feel some of this low back pain, and/or some of the sciatica?
Dr. Smith: We would recommend that you see your general family practitioner or internal medicine physician, or if you have access to getting into an orthopedic office right away you can certainly come and see an orthopedist. Sometimes the patient’s insurance carrier will require a referral from their general medical physician.
Melanie: And what are some nonsurgical treatments, and the first line of defense? Would NSAIDs, or cortisone shots, or any of these things people hear about, would any of these help with a herniated disc?
Dr. Smith: Some of the first line treatments for herniated discs are non-surgical treatment because we do know from what the studies tell us that most back pain, as well as back and sciatica leg pain, will usually resolve within the first six to nine weeks with adequate non-surgical, conservative treatment. These treatments would include a combination of physical therapy, non-steroidal anti-inflammatory medication, rest, and activity modification.
Melanie: And what about an epidural? Is that something that gets considered in this case?
Dr. Smith: An epidural would be considered in this instance to try to help alleviate some of that sciatica leg pain that the patient experiences after they’ve tried some of the initial conservative measures, such as physical therapy and anti-inflammatory medications.
Melanie: How often can someone get an epidural steroid injection before you say, “That’s enough?”
Dr. Smith: Epidural steroid injections can be given usually up to three injections within a six-month period of time. If, however, the patient is failing all other conservative measures, as well as epidural injections, we would consider surgical intervention. As long as there’s no progressive neurological deficits, or paralysis noted on the patient’s exam, it is still acceptable to treat conservatively. However, if they do develop any progressive paralysis or something known as a drop-foot, then we would have a more serious discussion regarding surgical intervention.
Melanie: Would a disc herniation take care of itself? We’ll talk about surgery and the procedure for it, but is it something that can go away, or is it always kind of there, nagging — maybe not as bad as it is when sciatica attacks you, but does it go away, Dr. Smith?
Dr. Smith: Herniated discs never usually completely go away. We do think the body has the ability to resorb or pull that disc herniation in maybe just a few millimeters, and that just relieves the compression on that nerve root that it might be pinching in your spine, and then the leg pain will improve. And usually, the back pain will improve, as well, with conservative treatment.
Melanie: And what might be some surgical treatment for this condition?
Dr. Smith: The surgical procedure for a herniated disc that is causing sciatica down your leg is a microdiscectomy procedure.
Melanie: And what is that like? Explain the procedure just a little bit.
Dr. Smith: In a microdiscectomy procedure, we remove a small amount of bone in your spine to make the space between two of your vertebrae wider so that we can get special retractors in there in order to pull the nerve roots to the side, so they are protected and give us access to that piece of herniated disc that has come out of the disc space and causing compression or pinching of the nerve roots. That piece of herniated disc is removed, and then the retractors are removed, allowing the nerve root to return to its normal position. It no longer has any compression or pinches on it because the disc herniated fragment has been removed.
Melanie: What would you like to tell patients that are suffering from the pain of sciatica and a herniated disc, about possibly preventing it in the first place, and what to do if that pain becomes really, truly unbearable?
Dr. Smith: In order to prevent herniated disc, a good overall healthy body weight, as well as good lifting mechanics are needed. Usually, we will start patients on a physical therapy program to work on lumbar muscle strengthening, as well as core strengthening of the abdominal muscles, and get them into what’s called a “Healthy Back Program” in the physical therapy office.
Melanie: Thank you, so much, for being with us today. You’re listening to Memorial Health Radio with Memorial Health System, and for more information, you can go to MHSystem.org, that’s MHSystem.org. This is Melanie Cole. Thanks, so much, for listening.
