Spinal discs has very important role in the lower back as they act as a shock absorbers between the vertebrae (spine) and supports the upper body, and allowing unrestricted body movement. Herniated disc or ruptured disc occurs when one of the spinal discs cracks in its outer wall and its inner disc material is pushed out into the spinal canal causing pain and discomfort. Most often, it can occur anywhere in the spine, even in neck or lumbar vertebrae. A lumber herniated disc is one of the most common causes of sciatica.
Herniated disc or ruptured disc can happen due to few factors such as:
• Age – most commonly between the ages of 35 and 50.
• Gender – men are more prone to developing lumbar herniated disc as compared to women
• Heavy physical work – like heavy lifting and physical labor such as pulling, pushing or twisting
• Over weight – people with excessive weight are more at the risk of developing of herniated disc.
• Smoking – smoking can limit the blood flow to spinal disc eventually leading to degeneration of spine and may also hampers healing process.
• Family history – herniated disc or ruptured disc can be hereditary.
There are some general signs and symptoms of herniated or ruptured disc that may include:
• Radiating leg pain
• Sharp or piercing pain in nerves
• Numbness, weakness or tingling in the leg, foot or toes.
• Difficulty in lifting foot while walking or standing (foot drop)
• Lower back pain or muscle spasm
• Increased pain due to prolonged standing or sitting
• Worsening pain from hunching forward
In many cases, pain from herniated disc gets better within few days or weeks. It can be treated with non-surgical methods such as restricting heavy exercises or activities, applying heat or ice packs, rest, taking nonsteroidal anti-inflammatory medicines or muscle relaxants, taking physical therapy etc. but if the symptoms are improving significantly with conservative methods, doctor may recommend surgery.
Before the surgery, doctor will perform several tests such as physical exam, overall health conditions, X-rays, CT scans, EMG/NCS, MRI etc to determine the cause of the pain.
There are different types of surgery for herniated discs:
• Laminotomy/laminectomy - a small opening is made with the aid of a microscope in the lamina to relieve the pressure on the nerve roots is called laminotomy whereas in laminectomy, lamina is removed completely if required.
• Diskectomy/microdiskectomy – is commonly used surgical procedure for herniated disc in the lumbar. A part of disc or the entire disc that is causing the pressure on the nerve root is removed in this method. When surgeon makes a small incision in the back or neck to access the disc with special instruments to achieve the desired results with less invasive procedure it is called microdiskectomy.
• Artificial disk surgery – patient will be given a general anesthesia. This surgery is usually used for a single disk when the problem is in the lower back. Surgeon makes an incision in the stomach and replaced the damaged disc with an artificial plastic and metal disc. Patient may require staying at the hospital for couple of days after this surgery. Patient who has degenerative discs, arthritis or osteoporosis should avoid this surgery.
• Spinal fusion – Spinal fusion is done under the influence of general anesthesia in which two or more vertebrae are permanently fused together that can be done with bone grafts from another part of your body or from a donor. To provide additional support to the spine, metal or plastic screws and rods may be used that will permanently immobilize the portion of your spine. This procedure usually requires a hospital stay of several days. In some cases, a person may require a combination of surgeries.
Doctor will recommend some pain relievers, physiotherapy, may ask patient to avoid some strenuous exercises, heavy weight lifting, and smoking and should take proper diet and nutrition. There are some complications involved with surgery for herniated disc that includes:
• nerve damage
• blood clotting