OPTIONS FOR TREATING A HERNIATED DISC

What Is The Best Treatment For Herniated Disc?

Herniated Disc is a condition known to occur along the region of the spine. It can be a herniation that occurs along the route of the cervical spine or one which occurs in the lumbar region. When it comes with a slipping or bulging disc in the low back region, it can result in a situation commonly known as sciatica, where the low back pain radiates from the back to the legs and toes. This condition can elicit a lot of pain; which can either resolve on its own or through the application of conservative treatment protocols.

Anatomy
Anatomy describes the parts of the body. The anatomy of the spine includes the following:

The spine is made up of 24 bones,7 make up the cervical spine, 12 make up the thoracic spine and 5 make up the lumbar and sacral regions respectively
The bones are connected through the intervertebral discs
The intervertebral discs possess spaces in between them, creating a canal that protects the spinal cord from harm.
The discs are flat, flexible and round, making them able to withstand some form of compression or tension forces.
They also help in shock absorption as you go about your normal daily activities.
The intervertebral discs are made up of the annulus fibrosus and nucleus pulposus
Annulus fibrosus from the outer part of the disc, it is flexible and tough
Nuclear pulposus is more fragile, jelly-like and contained at the centre of the disc
The Spinal cord houses the spinal nerve roots which branch out to carry messages to the brain and other parts of the body.

How the herniation occurs
The herniation occurs when the nucleus pushes against the annulus fibrosus (the outer ring of the disc). This can happen as a result of a sudden injury to the back or repetitive trauma to the back. This pressure can lead to the occurrence of low back pain. Once there is continual trauma applied to the disc, the degree of protrusion of the nucleus might be farther away from the disc, putting pressure on the spinal cord and the nerve roots. The body goes into an inflammatory reaction as a result of this. Some of the irritants released during this process can lead to the irritation of the nerve roots and its nerves. Irritation of the nerve and its nerve roots leads to herniated disc symptoms or sciatica depending on the severity.

Herniated disc Symptoms:

It results due to wear and tear in the spine known as degeneration of the disc.
Occurs as a result of a reduction in the water content of the disc
Low back pain is often the first symptom to present. Other symptoms include
Tingling sensations
Numbness
Sciatica: A shooting pain which goes down to the legs from the buttocks
Muscle weakness in the leg
Urinary or faecal incontinence depends on the severity of the condition.

Predisposing factors
Some factors can predispose one to have certain conditions such as a herniated disc. They include:

Bad Lifting techniques: Proper lifting techniques protect the back against sudden trauma and the overall effect of great compressive and tension forces. When bad lifting techniques are practised, the bones of the spine are exposed. The muscles of the back are then recruited into carrying heavy objects. A sudden twist in the wrong direction can cause disc herniation.

Weight: Being overweight increases the amount of stress on the discs especially in the low back.

Strain: A repetitive activity that puts a strain on the back is a risk factor. People involved in jobs that require pushing, pulling, bending and other quick manoeuvres are at risk.

Gender: Men (20-50) years are more predisposed to having herniated discs due to the kind of physical activities they engage in.

Sedentary lifestyle: Living a sedentary lifestyle does not help prevent the occurrence of sciatica.

Clinical Examination Protocol
Medical History
When these symptoms present, the first thing your doctor will ask for is your medical history. A comprehensive medical history is required to help direct appropriate diagnosis.

Physical Examination
Physical examination is often performed by the physician especially after discussing your symptoms.

The examination is often done in parts:
Neurological examination: This is aimed at testing the integrity of your muscles and nerves to determine if there is any loss of sensation or abnormality. Your doctor will check for the following:

Sensation: By checking how well you can sense warmth, cold, heat
Coordination: By checking how well you can walk on your heels and toes
Muscle strength
Straight Leg raise: Your doctor will ask you to raise your leg in a straight fashion to determine the involvement of the sciatic nerve. Inability to keep your leg straight will be a strong indication of sciatica and herniated disc
Reflexes: Patella tendon reflex will be check for possible compression

Imaging
MRI: Most often, your doctor will require some form of the imaging modality to confirm his clinical impression. An MRI scan gives a graphical representation of the body tissues, bones and fluids, sometimes after a particular kind of contrast is applied. It can also reveal in specificity the affected nerve roots.
If an MRI cannot be performed, your doctor might opt for Xray or CT scan to work with.
(insert here the illustration of an MRI, CT, or Xray, showing disc herniation)

Treatment
There are different treatment modalities for herniated lumbar discs. They are as follows:

Conservative management
Non-conservative management

Although for some people, improvement in the level of pain will be recorded a few weeks after the onset of pain, the recovery period might be slow with some episodes of pain following the treatment.

Conservative treatment
Initial treatment for a herniated disk is usually nonsurgical. Treatment focuses on providing pain relief. Nonsurgical treatment may include:

Physiotherapy
Physical Therapy deals with the use of a non-invasive technique to improve the quality of life of those with lumbar disc herniation. It incorporates exercise techniques to strengthen the back muscles to relieve the pressure in the lumbar region. Positioning is also utilized as well as relaxation for better outcomes. In the past, patients with disc herniation were always advised to get maximal rest by staying in bed, however, been in lying position for about 2 weeks can further weaken the muscles of the back, leading to worsening of the condition. These days, people with lumbar disc herniation are advised to be reasonably active, to prevent weakness of the muscles of the back.

Manual therapy
Manual therapy incorporates special treatment techniques and manoeuvres in the treatment of sciatica. It also incorporates massages to relax tensed up muscles and joints that are locked. Also, physical techniques are used to relieve pain because of their analgesic properties (for example, the use of ice to relieve pain). Heating and cooling backs utilize hot packs and patches as a form of physical stimuli in pain management. Heat is proficient in relaxing tensed muscles (e.g, the use of infrared lamps).

Ultrasound therapy can also be used to treat the back with the help of sound waves. These sound waves produce small vibrations that can help heal and relax the body tissues while probing relief from pain.

Passive therapy does not necessarily completely take all the pain away. They are useful in relaxation and pain relief.

Medications
Quite a number of medications are useful in relieving pain which results from disc herniation. Although some of the medications are pain killers, others are muscle relaxants and anti-inflammatory agents.

The following are facts about Non-steroidal anti-inflammatory drugs (NSAIDs):

They are effective painkillers
Examples include diclofenac, ibuprofen and others
They have anti-inflammatory and analgesic effects
They may cause some degree of bleeding sometimes (such as nose bleeding).
They belong to the same family of drugs like aspirin
When overused, they can cause stomach ulcers and some damages to the kidney and liver
They can also cause nerve damage if given at an injection site without necessary precautions.

Acetaminophen (paracetamol).
The following are facts about acetaminophen:

It is a painkiller
It is well tolerated
It has weak anti-inflammatory action
It is not an NSAID but it is useful for people who cannot tolerate NSAIDs due to stomach ulcers
Not more than 4 grams is needed for effectiveness
Higher doses of Acetaminophen can cause damages to the liver and kidneys

Surgical Treatment
If conservative management fails, then some patients will require surgical intervention especially if they are still experiencing muscle weakness, urinary and faecal incontinence and a lot of pain. Some of the surgical procedures include:

Microdiscectomy

It is a common procedure used in the treatment of single disc herniation
It is done through a small incision put through at the level of affectation
Removal of the herniated part is done
The pressure is relieved on the spinal nerves
Rehabilitation is often commenced by the physical therapist to foster recovery
It can include a range of exercises and other modalities according to the needs of the body
Special education is often given to patients to prevent a repeat occurrence

N: B Surgical risks are involved with this procedure. Bleeding and infection can set in if proper precautions are not taken. Some other complications are:

Reactions from anaesthesia
Injury to the nerve
Recurrence of herniation
Hematoma formation and build-up, resulting in further nerve compression
Infection
Dural tears

Conclusion
Conservative management is usually the first line of management given to patients. Upon improvement, activities are modified and proper education given to avoid reoccurrence of the herniation.

Microdiscectomy surgery has a good prognosis and usually yields better improvement because patients are often able to resume activities of daily living. Your doctor will be able to talk to you about the conservative and non-conservative treatment techniques.