Herniated discs are quite common, especially in the lumbar spine (lower back). When patients with herniated discs come to see me, they are often in quite a bit of pain and anxious to start feeling better. Here’s how I describe what’s going on and how I can help them with their recovery.
A herniated disc is like …
Doctors frequently use analogies to help explain the human anatomy to a patient. When it comes to the intervertebral discs in the spine, a classic analogy is that of a jelly donut. You have the outer shell of the donut with the soft jelly in the middle, similar to the firm outer casing of an intervertebral disc with the softer, gel-like nucleus inside. Picture this “donut” in between each of the small bones of your spine. If some type of force or pressure is placed on it, the donut can break open and the jelly will squeeze out. The jelly can then press on your spinal nerves in that area and cause pain. That jelly also causes a large amount of inflammation around your nerves, giving you the sensation of burning that runs down your leg.
When you think about your spine, your lumbar spine has the greatest concentration of stress placed on it. Your cervical spine only has to support the weight of your head. Your thoracic spine doesn’t move as much and has the protection of your ribs. But your lumbar spine supports your whole upper body and is responsible for a lot of movement. All of that pressure makes it more likely for a disc to herniate in that area.
I have a lumbar herniated disc. What’s next?
The pain from a lumbar herniated disc often comes on acutely, or suddenly. Though you may have some pain in your lower back, the more telling sign of a herniated disc is often radiating leg pain from the pressure on your sciatic nerve.
There are a few things you can do at home to help with your symptoms. Nonsteroidal anti-inflammatories such as ibuprofen can be used to improve pain and stiffness. Applying heat or ice to the area may also provide some relief. A period of rest can help as well, but it’s important to understand that going on complete bed rest or extending it too long can actually make your pain worse.
This is where the guidance of a spine specialist can be useful. The majority of cases of herniated discs will not require surgery, but if you are under the care of a doctor, you may find a pain management and treatment plan that will get you feeling better quicker. From muscle relaxants to physical therapy to steroid injections, there are a number of things we can try to decrease your pain and improve your activity and mobility.
How will I know if I need surgery to fix my herniated disc?
If you’re not feeling better after several weeks of nonsurgical treatments, we may discuss surgery. Often, this can be done with a minimally invasive procedure to remove the herniated disc material while taking care to leave the remainder of your disc alone. This will relieve the pressure on the spinal nerves, giving your disc the best chance for healing.
We’ll also monitor you for the development of any neurologic deficits. This is when a part of your body doesn’t function as it should because of compression on your nerves or spinal cord. Numbness, tingling, or difficulty walking are some good examples. If anything like this occurs, we may recommend surgery sooner rather than later, in order to avoid any permanent nerve damage. If you are experiencing loss of bladder or bowel control we recommend going to the emergency room immediately.
Though herniated discs can cause quite a bit of discomfort, most will heal successfully with good non-surgical management. For those that are persistently disabling a minimally invasive surgery can fix your problem and get you back to your normal life. My goal is to facilitate this process and help you achieve the results you desire.
About the author
Grant D. Shifflett, MD Dr. Grant D. Shifflett is a fellowship-trained orthopedic spine surgeon. Handpicked by Dr. Robert S. Bray Jr. to join DISC Sports & Spine Center, Dr. Shifflett specializes in the application of minimally invasive and microsurgical techniques to the entire spectrum of cervical, thoracic and lumbar spinal conditions, from the simple to the most complex. Whether treating a patient with chronic pain or an acute injury, his ultimate goal is to restore function and quality of life with minimal tissue disruption. Read more articles by Grant D. Shifflett, MD.