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When considering a herniated disc we must be aware that there are multiple segments of the spine that may be affected.
Cervical herniated disc:
The cervical section of the spine refers to the region of the neck. The herniated disc will most often occur between the sixth and seventh cervical vertebra bodies. The symptoms caused by a cervical herniated disc will often affect the back of the skull, the neck, shoulder, scapula, arm and hand. Cervical plexus and brachial plexus nerves can be affected by a cervical herniated disc.
Thoracic herniated disc:
Herniated discs in the thoracic region are quite rare because the disc in the thoracic region are very stable. A herniated disc in the uppermost thoracic region of the spine can sometimes mimic a cervical herniated disc while on the opposite end of the spectrum; a herniated lower thoracic disc can mimic a lumbar herniated disc.
Lumbar herniated disc:
A herniated disc in the lumbar segment of the spine will most often occur between the fourth and fifth vertebral bodies or between the fifth and the sacrum. The symptoms of the herniated disc may affect the lower back, buttocks, thigh with pain that can radiate down into the foot and/or toe. A lumbar herniated disc will most commonly affect the sciatic nerve, bringing on symptoms of sciatica. Although not as often, the femoral nerve can also be affected by a lumbar herniated disc which may cause the patient to experience a numb tingling feeling throughout both legs and sometimes even the feet.
Most herniated discs do not require surgery and will heal themselves over a period of about six weeks. To combat the pain caused by the herniated disc during this healing time pain medications are often prescribed to help alleviate the pain and allow the patient to begin exercising and stretching.
Cauda equina syndrome causes symptoms of incontinence, weakness and genital numbness, and the presence of this is considered a medical emergency. Cauda equina syndrome requires immediate medical attention and possibly surgical decompression.
Treatment goals for a herniated disc during the healing stage:
Seeing as on average a herniated disc will take between one and six months to heal on their own, the painful symptoms will be combated during this stage to try and keep the patient as symptom free as possible. The patient will be educated on exercises and techniques during this process which will help him or her prevent further injury as well as strengthening the back.
Nonsurgical treatment methods are usually explored as a first option with some of the techniques listed below:
- Bed rest with a gradual increase in the patients activity level
- Anti-inflammatory and pain control medications
- Exercise to help strengthen the back muscles provides added stability which helps to reduce the pain
If a patient does not show improvement within the first six months of treatments (about 10%), surgery for the herniated disc is often suggested and preformed. When looking for a minimally invasive surgery a percutaneous endoscopic discectomy may be preformed.
Percutaneous Endoscopic Discectomy:
This is a laser spine procedure which will remove the portion of the extruding or herniated disc that is now pressing against a nerve causing the symptoms. By removing or shrinking the herniated disc with a laser, the spinal cord becomes decompressed freeing the spinal cord or nerve root that is being impinged. At this point excess disc material is removed and the symptoms of a herniated disc generally disappear.