When Does A Herniated Disc Require Surgery?
In between each of the vertebrae of the spine, there are discs that cushion the vertebral bones in the spine. These small discs have a tough outer layer (annulus) with a jellylike material on the inside (nucleus). A herniated disc occurs when a part of the jellylike nucleus pushes its way out into the small spinal canal through a tear in the harder outer layer of the disc. The spinal canal is not big enough to hold both that nucleus and the nerve, therefore the nerves of the spine may become compressed and cause a variety of symptoms.
Diagnosis and Nonsurgical Treatment of a Herniated Disc
The diagnosis of a herniated disc can be made several ways, including a history and clinical exam, CT scan, MRI, and electromyogram or nerve conduction study. Once the diagnosis is made, there are a number of treatment options available.
Initial treatments for herniated disc include conservative measures such as rest, non-steroid anti-inflammatories, epidural steroid injections, and physical therapy. In fact, 80% of disc herniations improve without surgery. Many treatments are done in conjunction with physical therapy and medication in an effort to strengthen the muscles surrounding the spine and alleviate the painful symptoms of a disc herniation.
For those who have not found relief with conservative modalities, surgery may be an option.
Surgical Treatment of a Herniated Disc
For those who have pain that is incapacitating and affecting the quality of life, then a surgical intervention should be discussed with a spine specialist.
- Spinal surgery is generally considered when one or more of the following is present: ·
- Conservative measures have failed.
- Back pain radiates to the legs and buttocks. (Sciatica)
- Pain is constant and/or interferes with normal activity or quality of life.
- There are progressive neurological deficits such as weakness or numbness in the legs.
- There is difficulty with walking and standing.
- There is a loss of normal bowel and bladder function.
Fortunately, recent advancements in surgical technology have allowed many of these procedures to be performed using what is known as a Minimally Invasive Approach. With this more advanced approach, only a small incision is made (1-2 inches) in conjunction with real-time X-ray technology (fluoroscopy) to access only the affected disc. Once this disc is accessed, the herniated portions can be removed, thus alleviating pressure on the spinal nerve. Most patients are up and walking shortly after their procedure and are allowed to able home the same day. This approach also shortens the recovery profile substantially and patients are able to return to work and physical activity sooner.
There are several types of surgery that can be performed and your procedure will be based on a variety of factors including your age, lifestyle, and severity of the injury. Your spine specialist will review which options are available and which would yield the greatest benefit.
Dr. Anthony Virella is a Board-Certified, Fellowship trained Neurological Spine Surgeon with advanced training in the management of complex spinal disorders. He attended medical school at Columbia University College of Physicians and Surgeons and is a graduate of the UCLA Neurosurgery Residency Program. Dr. Virella completed his complex spine in-folding resident fellowship at the world renowned Cleveland Clinic Foundation with Dr. Edward C. Benzel, M.D. Additional work included a second fellowship in Minimally Invasive Spine Surgery at the UCLA Comprehensive Spine Center.
Dr. Virella is a nationally recognized specialist in the field of complex and Minimally Invasive Spine Surgery and has offices located in Agoura Hills, Valencia and Palmdale.
If you, or someone you love, is suffering from persistent neck or back pain, contact us today to schedule an appointment.