Between each pair of vertebrae in the spine are shock-absorbing inter-vertebral disc. Each disc has a strong outer ring, called the annulus, and a soft, gelatinous center that acts as the shock absorber between the vertebrae, called the nucleus pulposus. When the annulus tears, the soft nucleus can protrude into the spinal canal. This is called a herniated disc. Herniated discs can become very painful if the damaged disc leaks fluid or compresses the nerve roots.
Herniated discs can be caused by wear and tear, degeneration, or trauma. Discs heal from a tear by forming scar tissue, which is weaker than normal tissue. Repeated injuries can further weaken the annulus, in which case even a small amount of force can result in disc rupture.
A herniated disc that compresses a nerve root can cause pain in the arms or legs in addition to causing back pain. The hallmark of a herniated disc is radicular pain that runs down into the arm or leg, and may also be associated with numbness or weakness.
The doctor will begin by obtaining a complete history of the problem, administering a physical exam and reviewing the X-rays. An MRI is the most common test used to diagnose a herniated disc.
The treatment of a herniated disc depends on the symptoms. Your doctor may first suggest careful monitoring. If the symptoms improve, no other treatment may be needed. However, if symptoms worsen, your doctor might suggest surgery. Depending on the amount of pain, medications and/or physical therapy may be prescribed. For severe pain, an epidural steroid injection may be prescribed. Unfortunately, this treatment succeeds in reducing the pain in only about fifty percent of all cases and can "wear off". The surgical treatment for a herniated disc is a combination of laminotomy and discectomy. In a laminotomy, an opening is made in the bone overlying the affected spinal nerves; a discectomy removes the portion of the herniated disc that is compressing the nerve. Microdiscectomy achieves the same results as traditional discectomy, but can now often be done through a dime sized, minimally invasive approach, allowing most patients to go home hours after the procedure.
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