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Herniation of a Intervertebral Disk
What is an intervertebral disc?
These discs separate and cushion the vertebrae, the segments of the bony spinal column, which form the main structural support of the skeleton of humans and other vertebrates, it is also known as the vertebral column or backbone. They give flexibility to the backbone, functioning like shock absorbers during movement. Discs are made of an outer rim of fibrous connective tissue and a gelatin-like inner core, called nucleus pulposus. If the fibrous rim breaks the core may bulge into the spinal canal, resulting in pain because material from the disc will press on spinal nerves. This can also cause numbness or tingling, weakness, or paralysis in the area of the body enervated by those nerves. |
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| Back pain caused by a Lumbar Hernial Disk |
What is the herniation of an intervertebral disk and how is it produced?
It is the deformity of the disc when there is a partial rupture of the outer part of the disc, the fibrous rim. This debilitates the wall and produces an expansion of the nucleus, which pushes part of the disc, toward the back bulging. Material from the disc will press on spinal nerves and in severe cases even the spinal cord. This can also cause numbness or tingling, weakness, or paralysis in the area of the body enervated by those nerves.
If the fibrous rim breaks the core may bulge into the spinal canal, resulting in pain because material from the disc will press on spinal nerves. This can also cause numbness or tingling, weakness, or paralysis in the area of the body enervated by those nerves, sometimes it can even press on the spinal cord if the deformity is severe.
Why is the herniation of an intervertebral disk produced?
The herniation of an intervertebral disc is produced when there is a sudden increase in its pressure produced by the superior and inferior vertebrae. This can happen as the result of a fall, of lifting heavy weights, of a sudden turn or by weakness occurred with age. Obesity can also produce increased pressure in the disc. Smoking can contribute to the degeneration of tissue of the discs.
Where is herniation of an intervertebral disk produced?
90% of these hernias are produced at low levels of lumbar segments (L4-L5 o L5-S1). They will produce lower back pain which irradiates towards leg and foot. Less frequent are cervical hernias (neck), in this case pain can irradiate from the neck towards arm and fingers.
How it is Diagnosed?
1.- By a clinical examination concentrating on the characteristics of pain.
2.- MRI, which will give the most information.
3.- Mielography.
4.- Electromyography, which reveals any nerve damage, measuring electrical activity of the muscle.
What are the symptoms of a discal hernia?
It is pain which will follow a physical strain or trauma. Pain varies in relation to the level of the damaged disc :
- Ciatalgia: is the pain that irradiates from the lower back, through hip, towards the back of the leg, knee and to the foot.
- Numbness of the leg.
- Loss of urinary or intestinal control.
The intensity of pain is in direct relation to the pressure which the herniated disc places on the spinal nerve.
If there is only back pain, it can be caused by a discal hernia, but it can also be originated by different causes. The pain caused by a discal hernias, usually worsens with physical activity and decreases with rest. Coughing, sneezing, driving or flexing the spinal cord, elevates the pressure of the disc towards the spinal nerve, increasing the pain.
What is the treatment for a discal hernia?
1.- For most cases, a discal hernia will only need two to four days of bed rest with pain killers, anti inflammatory drugs prescribed by your physician. Depending on the severity, physical therapy could be recommended.
If this phase of the treatment does not work, the following alternatives are a possibility :
2.- Surgery : performed with general anesthesia, it is an open surgery that includes bone resection and extraction of the nucleus pulposus. It requires several days of hospitalization and a slow recovery time. This is recommended when there is an associated pathology with discal hernia or part of the disc has slipped out of place.
3.- Percutaneous Nucleoplasty : many minimally-invasive methods are available, whereby the entire decompression is performed percutaneously through a needle. Patients who can benefit from percutaneous disc decompression or 'percutaneous discectomy' , are those with pain from a contained herniated disc, where there is no rupture in the outer wall. This technique needs no big cuts, hospitalization time or general anesthesia. It is now an accepted and renowned technique because of its efficacy, good clinical response of patients and because it is practically an ambulatory procedure.
It can be performed in three ways: with radiofrequency, Laser and with needle, which permits the removal of part of the disc, mechanically or with a thermal treatment. All of which will decrease pressure and alleviate the pain almost immediately.
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What treatment option do you recommend and offer?
After having tried a medical treatment with bed rest, anti inflammatory drugs and physical therapy, pain should be controlled. If pain has not subsided and symptoms persist, the best alternative is Percutaneus Nucleoplasty.
We offer Laser Nucleoplasty. Where we apply Laser thermal therapy (with no distress for the patient) the nucleus pulposus will disintegrate and part of it extracted.
What are the indications after the procedure is done?
• Resume habitual daily activity in a gradual way.
• Avoid weight lifting for at least a month, after this start doing so in a progressive way. Sudden and too heavy weight lifting must be always avoided.
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