FAQ’s Herniated or Bulging Disc Treatment in Las Vegas

Herniated Disc

Intervertebral discs are rubbery, flexible pads that lie between the spinal bones (vertebrae). A herniated disc occurs when the inner portion of the disc protrudes through the outer layer. This condition causes serious back pain, as well as leg symptoms

What causes a herniated disc?

The inner gel-like material is called the nucleus propulsus. This material is surrounded by a thick outer ring, which is called the annulus. Discs contain around 90% water, and when the inner material pushes through the outer layers, it can irritate or compress surrounding spinal nerves.

Are herniated discs common?

According to recent statistics, a herniated disc affects around 2% of the general population. This condition is more common among people ages 30 to 50 years of age, and men are affected twice as often as women. Approximately 95% of disc herniations occur in the lumbar (lower back) spine.

What risk factors are associated with a herniated disc?

As the discs age, they lose water content. This causes loss of shock-absorbing ability and decreases flexibility. In addition, the spaces between the disc grow closer, causing spinal column narrowing. Risk factors that contribute to herniated discs include:

  • Improper lifting
  • Repetitive strenuous activities
  • Excessive body weight
  • Smoking

What symptoms are associated with a herniated disc?

The main symptoms of a herniated disc is back pain. Because of spinal nerve root irritation or compression, patients often experience sciatica (a sharp, shooting pain going down the buttock, back of the thigh, and into the lower leg/foot). Other symptoms include leg numbness, tingling, weakness, and burning. If the herniated disc is in the cervical (neck) area, it will cause arm burning, weakness, numbness, and tingling.

How does the doctor diagnose a herniated disc?

If you experience lower back pain and symptoms of sciatica, the doctor will ask several questions regarding symptoms and take a detailed medical history. The doctor will also conduct a physical examine and order some tests. Diagnostic testing includes x-rays and magnetic resonance imaging (MRI) scans.

What are the treatment options for a herniated disc?

The treatment of a disc herniation depends on the extent of the problem, the severity of the pain, and associated symptoms. Options are:

  • Physical therapy – To help the patient strengthen stomach and back muscles, the physical therapist will work you in a structured rehabilitation program. Pain relief options used in therapy include electrical stimulation, massage, heat/cold therapy, and ultrasound.
  • Medications – The pain management specialist may use a combination of medications for pain relief. If muscle spasms occur, a muscle relaxant can be ordered (Robaxin or Baclofen). Antidepressants and anticonvulsants are both used to control nerve pain. For mild pain, nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed. If pain is severe, narcotic analgesics are used short-term.
  • Epidural steroid injection (ESI) – A steroid can be injected between the epidural layer and the spinal cord (epidural space). This decreases nerve irritation and inflammation. Based on recent clinical reports, ESI is around 90% effective for back pain relief.
  • Selective nerve root block (SNRB) – The doctor can insert a small needle near the affected nerves using fluoroscopy (x-ray guidance). This is done to instill a long-acting anesthetic onto the nerves. Based on a recent clinical study, this procedure has an 80% success rate.
  • Transcutaneous electrical nerve stimulation (TENS) – This external device is used when other treatments fail. Electrodes are place on the skin above the painful disc region, and the battery-powered unit delivers mild electric current. Based on research reports, the efficacy rate for TENS is 75-90%.
  • Radiofrequency denervation – When the patient has severe nerve pain, the doctor can insert a special needle and probe through the skin, and position it near the affected disc. Radiofrequency energy is emitted onto the nerves to interrupt pain signal transmission. This procedure was found to offer long-term relief of pain in a clinical study.

Resources

Kemler MA, Barendse GA, van Kleef M, de Vet HC, et al. (2000). Spinal cord stimulation in patients with reflex sympathetic dystrophy. NEJM, 343:618-24.

Manchikanti L, Cash KA, Pampati V, & Falco FJ. (2104). Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician, 17(4), 489-501.

Nagda, JV, Davis, CW, Bajwa, ZH, & Simopoulos, TT (2011). Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/segmental nerve for lumbar radicular pain. Pain Physician, 14(4), 371-376.

Riew KD, Park JB, Cho YS, et al. (2006). Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am, 88(8):1722-1725.