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Herniated Disc Treatments

Comprehensive Nonsurgical and Surgical Option.

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Herniated Disc Diagnosis

After discussing your medical history and your current symptoms, our doctor will perform a physical examination which depending on the region of your symptoms might include:  

  • Your ability to walk or stand on your toes
  • Whether you can feel certain sensations such as pinpricks
  • Your ability to flex and extend your ankle
  • Your reflexes (e.g. striking the deep tendons in the knee, bicep, elbow, or ankle with a reflex hammer)
  • Your range of motion (e.g. your ability to turn your head)
  • Your muscle strength such as lifting your arm or leg on your own and with light resistance

Our doctor may also order one or more of the following tests:

  • X-ray: Although an X-ray cannot reveal a bulging or herniated disc, it can be used to eliminate other causes of back pain.
  • MRI: An MRI can detect a bulging or herniated disc and reveal which nerves are compressed.
  • CT scan: This test can provide cross-sectional images of your spine.
  • Myelogram: Injectable dye is used to reveal the presence of a herniated or bulging disc.
  • Nerve conduction study: This test helps to determine how your electrical nerve impulses are functioning.

Treatments

The aim of treatment is to minimize nerve damage and alleviate pain and other symptoms caused by the herniated disc. The type of treatment you receive will depend on the extent of the herniated disc, its location, and previous treatment outcomes. Typically, you will begin with a non-surgical treatment before surgical options are considered.

Non-surgical treatments for a herniated disc include: non-steroidal anti-inflammatory drugs (NSAIDs), heat and ice therapy, physical therapy, traction/manipulation, chiropractic therapy, opioid pain medications, and epidural injections and other inflammatory medications.

Generally, non-surgical treatments are used  for one month to two months before surgical alternatives are considered. Surgical intervention is recommended if the non-surgical options are not successful in treating your pain or your symptoms worsen (including loss of function) All surgical options are performed under general anesthesia. Our surgeon will make a small incision above the affected area on the front or back of the body depending on the surgical approach. After moving aside the muscles and tissue our surgeon will be able to see and operate on the vertebrae and discs.

Some surgical options for herniated discs include: microdiscectomy, discectomy, disc replacement, laminectomy, laminoplasty, laminotomy, hemilaminotomy, foraminotomy, and spinal fusion.

Treatment for a Cervical Herniated Disc

The first line of treatment for a herniated disc in the neck is NSAIDs such as ibuprofen and plenty of rest. If over-the-counter painkillers fail to relieve the pain, or the pain worsens, our doctors may prescribe oral steroids to treat the inflammation or oral opioids for more severe pain. If the pain lasts for four or more weeks, our doctor may recommend: Muscle relaxants, Physical therapy including stretching and gentle exercise, Ice or heat therapy or Chiropractic spine manipulation.

If the pain is severe or lasts for more than two weeks, our doctor may prescribe additional medications such as oral opioids for pain relief and oral steroids to alleviate inflammation. If the pain persists up to four weeks, our doctor may recommend one or more of the following: Physical therapy or stretching exercises, Gentle chiropractic manipulation, Epidural injections for pain relief or Cervical traction / Manipulation.

Surgical Treatments for a Cervical Herniated Disc

The aim of surgery for a cervical herniated disc is to remove a portion or the entire ruptured disc and relieve compression on the nerve root.

The aim of discectomy or microdiscectomy is to relieve pressure on the nerve root or spinal cord in the neck. Discectomy removes the entire disc while microdiscectomy removes the portion of the damaged disc causing the compression. These procedures can be performed through the front of the neck (anterior approach) or the back of the neck (posterior approach). If a discectomy is performed and the entire disc is removed the adjacent vertebrae can either be fused together or an artificial disc can be inserted to maintain a level of flexibility.

Overview

This procedure involves removing the entire disc and replacing it with a dynamic artificial cervical disc in the space between the two vertebrae to imitate the natural biomechanics of a healthy disc. This form of cervical stabilization is preferable to bone fusion as it allows you to retain more flexibility in your neck and studies have shown it results in superior clinical outcomes including better pain scores and a lower rate of adjacent level surgery or reoperation.

Recovery

Generally, you will be able to return home the same day of your Cervical Disc Replacement and to work within a week. You may be provided a cervical collar for your comfort and to stabilize your neck during your recovery. The full recovery time for Cervical Disc Replacement can take between four to six weeks. It is unlikely that you’ll experience some of the challenges associated with fusion such as esophagus irritation and shifting pain.

Overview

Surgery from the front of the neck (anterior) is preferable to surgery from behind (posterior) because it enables our surgeon to access the damaged disc without disturbing the spinal cord and thick neck muscles. 

Prior to surgery, you will be given a general anesthetic. Our surgeon will make a small incision in the throat. After moving aside the neck muscles, trachea, and esophagus, our surgeon will be able to see your vertebrae and discs. Once the damaged disc is removed, a spacer (generally bone graft) is inserted to replace the empty space. Then our surgeon will insert a metal plate held in place by metal screws in the adjacent vertebrae. Once the procedure is complete, our surgeon will move your esophagus, trachea, and muscle back and close the incision with sutures.

Recovery

Recovery time will vary from patient to patient. While some people are able to return to work within a few weeks, for others, it may take several months. Generally, you should be able to recommence light work around the home after three weeks. However, you should avoid lifting anything heavier than 10 pounds. When the fusion is fully healed the adjacent vertebra and bone graft will form one cohesive structure.

Challenges of Spinal Fusion Recovery

Along with some discomfort and fatigue, you may experience some challenges immediately following your spinal fusion. These include:

  • Shifting pain: You may be surprised to find that you feel pain in your shoulders and upper back as well as your neck. You may also feel tingling numbness in your arms during your recovery. 
  • Difficulty swallowing: For the first couple of days after your surgery you may have some difficulty or discomfort when swallowing. To minimize discomfort you should maintain a liquid diet for the first two days following surgery then gradually introduce soft foods such as soup or apple sauce. 
  • Difficulty speaking: For the first two days after your surgery you may experience some soreness and hoarseness in your throat. In some cases, it can take a week or two to completely recover your voice.
  • Constipation: It is quite common for people recovering from ACD surgery to experience constipation. This is often a side effect of opioid medication.
  • Non-union or delayed-union spinal fusion: also called failed spinal fusion or pseudarthrosis, this means that the bones did not properly fuse together. It can be caused by a variety of factors such as movement, inflammation/infection, a deficient bone graft, or the surgical misalignment of the vertebrae.

Other decompression procedures that could be considered for cervical herniation include: Laminectomy, Laminoplasty, Laminotomy, Hemilaminotomy or Foraminotomy.

Treatment for Lumbar Herniated Disc

Initially, our doctor will recommend conservative treatments. These include: Physical therapy, Non-steroidal anti-inflammatory drugs (NSAIDs), Ice and heat therapyOral steroidsChiropractic manipulation or Epidural injections.

Surgical Treatment for a Lumbar Herniated Disc

If conservative treatments are unsuccessful our doctor may consider surgical options. These include:

Initially, our doctor will recommend conservative treatments. These include: Physical therapy, Non-steroidal anti-inflammatory drugs (NSAIDs), Ice and heat therapyOral steroidsChiropractic manipulation or Epidural injections.

Surgical Treatment for a Lumbar Herniated Disc

If conservative treatments are unsuccessful our doctor may consider surgical options. These include:

Overview

This is the most common procedure for a lumbar herniated disc. The aim of this procedure is to remove the part of the damaged disc that is causing compression of the nerve.  A microdiscectomy in the lumbar spine is performed posteriorly and requires the removal of a portion of the lamina (hemilaminotomy or laminotomy) to have access to the disc, inside the spinal canal. After the portion of the disc has been removed and the nerve has been decompressed, our surgeon will close the incision with sutures. In contrast, if you have discectomy (removing the whole disc), there will be gap left behind that can either be filled by a lumbar artificial disc or the vertebrae can be fused together.

Recovery

You can usually return home the same day  following a microdiscectomy. You should be able to return to work within a week or two although your full recovery could take up to six weeks depending on your overall health. During this time, you should avoid lifting anything heavier than 5 pounds, bending or twisting, and driving. Try to get up and walk around for 5 minutes every few hours and increase this gradually.

Overview

The aim of this procedure is to relieve pain by decompressing the affected spinal cord.  After making an incision in the lower back and moving aside the muscle, our surgeon will remove the lamina. The lamina is the back arch of the vertebra that encompasess a portion of the spinal cord. By removing this arch the spinal canal is enlarged, which will decompress the spinal cord.

Recovery

You should be able to return home within 24 hours. You will be given pain medication to help relieve any discomfort in your back. You may need assistance getting in and out of bed for a few days following your surgery. You should avoid bending, lifting, and stooping for the first three weeks. You should also avoid long periods of sitting during this time.

Overview

The aim of this procedure is to remove and replace the entire herniated disc. This procedure requires a small incision that our surgeon will operate through. After removing the damaged disc, our surgeon will replace it with an artificial disc made of two metallic plates and a compressible plastic core that replicates the function of a natural disc. Once the disc is in place, our surgeon will close the incision.

Recovery

Recovery time for lumbar disc replacement is slightly longer than cervical disc replacement due to the increased intradiscal pressure (IDP) and weight-bearing function of the lumbar spine. You should be able to return home within 2-3 days of your lumbar disc replacement and may be provided a back brace to aid in your recovery. You will need to avoid bending and lifting for several weeks following your procedure. Items such as grabbers or slippers will help you avoid bending over. You should be able to return to work within several weeks of your procedure but your complete recovery may take several months. You will have physical therapy to learn how to do gentle stretches and exercises to help your trunk stay flexible. This will also strengthen your back and spine.

Treatment for Thoracic Disc Herniation

Thoracic disc herniation is typically treated with pain medication, such as NSAIDs and rest. Our doctor may recommend a back brace to limit the movement of your spine and help you move around. If your pain is severe, our doctor may prescribe opioid pain medication or epidural injections. If the condition does not resolve within two weeks and the disc is compressing a nerve root in the spinal canal, our doctor may recommend surgery.

Physical Therapy

If the symptoms are mild, our doctor will probably recommend a course of physical therapy. This will help you to:

  • Learn healthy ways to move your body
  • Learn correct posture
  • Learn techniques to help you manage your symptoms

Overview

The aim of this type of surgery is to open up the lamina – the arched part of the vertebra – and remove a portion of the damaged disc. Through a small incision in your back our surgeon will cut away or shave a small piece of the lamina (laminotomy) and remove the extrusion of the herniated disc (microdiscectomy). This will provide room for the nerve to heal. Our surgeon will then replace the muscle and suture the incision.

Recovery

You should be able to return home the same day of your surgery. Our doctor may recommend physical therapy as part of your healing process. If your goal is to return to work, providing your job does not entail any heavy lifting or long periods of sitting or walking, you should be able to resume work within one to two weeks.

Overview

This is a relatively new technique, the aim of which is to alleviate the pressure on the nerve root caused by the herniated disc. This type of surgery is performed under general anesthetia. Our surgeon will make a small incision in your side between your ribs and will access your spine through your chest cavity. A very small amount of the vertebra and damaged disc are removed – just enough to decompress the affected nerve root. After the nerve has been decompressed, our surgeon will close the incision.

Recovery

You will be required to stay in the hospital for 3-4 days. When you return home, you may need to wear a back brace for a few days to minimize the movement of your spine. You may need assistance with daily activities, such as bathing and dressing for a few weeks. You should avoid driving and strenuous activity for two weeks following surgery.

Overview

The goal of costotransversectomy is to relieve spinal pressure, reconstruct, and stabilize the thoracic region of the spine in the event of disc herniation. It is a safe alternative to open thoracotomy which requires opening a larger portion of the chest to operate. A costotransversectomy is performed anteriorly (front of the body) through a single incision. Our surgeon will remove the ends of one or more of your ribs where they are attached to the spine and a piece of the small bone on the side of the vertebra (the transverse process). This will provide access to the damaged disc. The part of the disc that has ruptured into the spinal canal and is compressing the nerve will be removed. The incision will then be closed.

Overview

This is a cutting-edge procedure for the treatment of thoracic herniated disc. Our surgeon will make a very small incision to pass a tiny camera through your chest cavity. While viewing on a TV screen, our surgeon can remove all or part of the herniated disc and decompress the nerve root.

Recovery

Because this procedure is minimally invasive, the recovery time is less than other surgical options. The discomfort in your chest will usually resolve within 2-3 weeks. Try to walk each day, and increase the distance gradually. Avoid exercise and any activity that may cause you to strain your back.

Physical Therapy After Herniated Disc Surgery

Physical therapy is an essential part of your recovery after your herniated disc surgery. The initial concern will be to reduce pain and inflammation and you can benefit from ice therapy, electrical stimulation such as TENS, and gentle massage. As your recovery progresses, your physical therapist will gradually add more activities. You will be taught exercises which will help to strengthen and stabilize your back. You will also learn about proper posture and safe ways to perform activities such as lifting objects. If your goal is to return to work, your physical therapist will be able to help you develop better habits to enable you to work safely.

Treatment for a Bulging Disc

Typically, a minor to moderate bulging disc can be treated non-surgically. The aim of treatment is to allow the damaged fibers in the annulus to heal so that the bulge can resolve. The stages of treatment include:

  • Pain relief: Our doctor will prescribe NSAIDs to help with the pain and inflammation. Depending on where the disc is bulging, you can also use ice and heat therapy, taping, bracing, or acupuncture.
  • Stregthening & Restoration: Once you are able to manage your pain, you will be able to start physical therapy. You will learn exercises that will help you to strengthen and stabilize your back and core muscles. As you regain strength and stability, your physical therapist will help you work on restoring the normal function of your spine and pelvis. This will help you to safely resume your normal daily activities.
  • Prevention: You will need to continue with your core strengthening exercise to prevent a recurrence. Exercising on a regular basis 2-3 times per week will help maintain strength and agility. 

Surgical Options for a Bulging Disc

If conservative treatments fail to resolve the symptoms, surgery may be needed. Depending on the location and severity of the bulge some surgical options for a bulging disc include decompression procedures such as microdiscectomy and laminectomy. (See Treatment for Lumbar Herniated Disc for more detail).

Alternative Treatments

Chiropractic Therapy: Gentle spinal manipulation performed by a qualified chiropractor can help to relieve back pain and other symptoms of a herniated or bulging disc. After discussing your medical history and current symptoms, the chiropractor may order an X-ray or MRI to assess the strength and functioning or your muscles, reflexes, nerve pathways, and your entire spine. Based on these assessments he or she will design a course of chiropractic therapy to suit your individual needs. 

Acupuncture: Acupuncture can be used as a method to relieve pain caused by herniated or bulging discs. Some physiological and psychological benefits of acupuncture include that the needles trigger the body to release natural endorphins (which reduces pain), relaxes your muscles, and increases blood flow. The practitioner will insert several very fine needles into your skin at the lumbar region of your spine. The needles will remain in place for around 20-40 minutes.

Treating a Herniated or Bulging Disc at Home

If you are suffering from mild to moderate pain from a herniated or bulging disc, here are some treatments you can use at home: 

  • Ice and heat therapy: Alternating hot and cold packs can help to relieve pain.
  • Rest: Minimize movement of the affected area.
  • Exercise: Gentle stretching and exercise can help relax and strengthen your muscles.
  • Medication: Over-the-counter NSAIDs can help reduce pain and inflammation.

At Miami Neurocisnce Center we can diagnose and provide the right treatment for herniated disc, call us at 786.871.6856 or schedule a consultation today.