Low back pain will affect almost 80 percent of Americans at some point in their lives. Beaumont surgeons treat thousands of these individuals every year.
Many patients can treat their pain without seeking medical attention through over-the-counter therapies like anti-inflammatory medications, heating pads, rest and physical therapy. However, some low back pain sufferers may be ailing from a condition known as a lumbar herniated nucleus pulposus, or herniated disc as it is more commonly referred.
A herniated disc occurs when the disc material breaks the disc annulus and impedes on a nerve root, essentially "pinching" the nerve. This can be a very symptomatic injury and patients with HNP usually present with leg and back pain often accompanied with numbness and/or weakness in the area. Another common symptom of herniated disc is parasthesia or tingling down the legs, usually concentrated to one side.
A herniated disc can be a painful intrusion to the daily routine for many people and although many conservative treatments are available, surgical intervention is sometimes the most effective approach to relieve a patient's symptoms and return the patient to a higher quality of life.
The three types of herniated disc are cervical, lumbar and thoracic.
Herniated Disc Symptoms
- Pinched nerve
The disc itself is not what causes pain for patients with a herniated disc. The pain comes from the protruding disc pinching or resting on a nerve. This pain of the nerve root is known as radicular pain and it may be felt in other parts of the body, such as down the leg from the lower back or down the arm from the neck. Sciatica or radiculopathy is the name given to pain in the leg caused by a pinched nerve.
- Disc pain
Pain for patients with a degenerated disc comes from the space of the disc itself. This is called axial pain.
Both pinched nerve and disc pain are herniated disc symptoms that can occur in the cervical, thoracic or lumbar spine. The lower back is the most common location because this is the area of the spine that is strained the most in the course of a day. Findings from CT or MRI scans are important, but not as meaningful in determining the cause of pain as are the symptoms a patient is experiencing and the results of the doctor's physical exam.
Herniated Disc Diagnosis
- Physical examination
A physical exam performed by a doctor will may include tests for any of the following, determined by the patient's symptoms:
- Function of nerves in specific areas of the arms and legs - The physician may use a reflex hammer to check reaction time for indication of a compressed nerve root. The physician may also conduct sensory tests to see how nerve roots react to hot and cold temperatures.
- Muscle strength - A neurological exam may be used to assess muscle strength so the doctor can determine if a herniated disc is compressing the nerve root. A visual exam to identify any muscle atrophy, twitching or other abnormalities may be utilized as well.
- Pain brought on by movement or touch - By feeling certain areas, a physician may gain insight into the cause of pain. Sacroiliac joint dysfunction may be indicated by pain over that joint when it is touched. A pinched nerve could be the cause of pain that comes about with the straightening of the leg. Degenerative disc could be the cause of pain with pressure on the lower back.
- Assess specific symptoms
Where the pain is located, how the pain feels and the impact certain activities, treatments and positions A complete review of symptoms will include the location of the pain, a description of how the pain feels, and the impact certain activities, positions or treatments have on the pain are all factors in determining its source.
- Medical history
To rule out or identify other conditions that may be causing pain to the patient, the physician will take a full medical history. This will cover previous diagnoses, recurring health problems, current medications, family history of illness, past treatments and surgeries, reactions to those treatments and other concerns the patient may have.
- Diagnostic tests
The doctor may order any of a number of diagnostic tests once an opinion on the diagnosis has been formed. This could help to confirm the disc problem and/or gain additional information about the location of the herniated disc or impinged nerve roots. These tests may include:
- A CT scan
Sends an x-ray beam through the body, then a computer processes the image to create cross sections of the spine.
- An MRI scan
Helps doctors accurately assess the spinal nerves and other spine anatomy. The scan will provide insight into disc alignment, height, hydration and configuration.
Findings from an MRI scan or other test do not constitute a herniated disc or degenerated disc diagnosis on their own. Many adults age 30 and older will have some level of disc problem, but pain will only be associated with a few of those issues. A physical exam and review of the patient's symptoms need to match the findings from the MRI or other tests to achieve an accurate medical diagnosis. Only with an accurate diagnosis can a physician prescribe an effective treatment plan for the patient.
Herniated Disc Treatment
For many patients, treatment for a herniated disc begins with a recommendation for conservative, non-surgical care before spine surgery for a herniated disc is considered. In some cases though, early surgical intervention is the recommendation. For example, for patients with a pinched nerve root caused by a herniated disc that is in turn resulting in progressive major weakness in the arms or legs, neurological progression can be stopped by early spine surgery. In this case, spine surgery creates an optimal healing environment for nerve recovery. Without surgical intervention in these cases, the nerve damage may become permanent.
A few relatively rare conditions commonly require immediate surgical intervention. Cauda equina syndrome is one of these conditions. It is usually marked by progressive leg weakness and/or sudden bladder or bowel dysfunction, and requires prompt medical care and surgery.