Treatment of Disk Herniations

Patients seek care for back pain more than almost any other condition. The most common cause of back pain is due to disc abnormalities. These can include degenerative disc disease, disc bulging, and disc herniations.

An intervertebral disc is comprised of an inner nucleus, the soft shell gel which fills the disc, and the outer annulus fibrosis, the fibrous tissue which gives strength to the disc. 

An injury occurs when forces are applied to the disc causing the nucleus to break through the annulus fibers. The disc herniation may press on the spinal cord and the roots causing back and or extremity pain

Initial treatment for a disc herniation is conservative. This can involve medications, a brief period of rest, and Physical Therapy.

The next level of treatment would involve epidural steroid injections, and finally if necessary, a discectomy.  Many people will achieve good benefit after injection therapy, but if symptoms persist, more aggressive treatment (ie surgery) may be warranted.

There are many different types of discectomies now being performed.  More minimally invasive include a percutaneous discectomy or endoscopic discectomy.  Open surgeries include an open microdiscectomy, or laminotomy, where the bone has to be removed to operate on the desk.

Percutaneous discectomy is very simple, safe, and has alow recuperated time.  It involves placing a trocar into the disk, whereby a small volume of the disc is removed.  This is used to treat small disc herniation‘s and contained disc bulges.  A patient can have treatment on a Friday and return to work the following Monday.

Another treatment is an endoscopic discectomy. This involves placing an endoscope at the area of the herniation.  Through a fiber optic system, which is transmitted to a television screen, the disc herniation is removed through a 1 cm incision. This also is minimally invasive with a low recuperate of time.

The goals of treatment are always to perform the least number and least invasive of therapies, and to achieve permanent benefit.  Back pain and disc herniation are in particular are very common.  Fortunately, most people will improve and return to normal function without surgery.  However if necessary, current surgical techniques are minimally invasive, with a low recuperate of time and high success rate.

Author
Dr. Todd Koppel

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