1. Orthopaedic Observations
A Matter of Medicine…
TM Pending
Herniated Discs
By Shirvinda Wijesekera, MD
We have all heard of cases of ter- their symptoms abate with these conservative measures.
rible back pain or sciatica. Some Most of those patients will have their symptoms consid-
of these ailments can be related to erably improve within 3 months or less.
a common injury to the interverte-
bral disc. The human interverte- In the smaller subset of patients that do not improve with
bral disc is a structure that lies conservative care or have worsening neurological exami-
between the vertebral bodies. It nation, surgical treatment is of-
functions as a shock absorber to ten possible. These microsurgi-
cushion the forces we all experi- cal techniques can result in pa-
ence throughout the course of the tients going home with a mini-
day. When this disc becomes mal scar, and a rapid recovery.
injured it can lead to a common scenario described by The techniques that past genera-
many names: herniated disc, slipped disc, ruptured disc, tions have had to endure have
or sciatica. changed. New techniques, have
led to better outcomes with much
The human disc has an outer layer of tough fibrous bands, less morbidity. Ultimately, your
much like those of a steel belted tire. These rings of tis- doctor can provide you with a
sue reinforce a soft center, the nucleus pulposis, which treatment regimen to return you
works as the force absorbing center. When the disc is to a normal life.
injured the tough rings can tear, allowing the soft nucleus
to extrude through the tear. Dr.Wijesekera is an Orthopaedic Spine Surgeon who
specializes in adult and pediatric surgery, spinal deform-
There are many grades or severities to these types of ity and spinal trauma.
tears. On occasion this can lead to a mild bulge in the
disc. At other times a complete tear can create a channel, He attended Boston University for his undergraduate
through which the soft nucleus can travel into the spinal studies. After graduating Alpha Omega Alpha from Bos-
canal. These two components, the torn outer layer of the ton University School of Medicine, he traveled to the Uni-
disc and the encroachment into the spinal canal leads to versity of Southern California-Los Angeles Medical Cen-
the common symptoms of back pain and sciatica. In ter where he completed his residency in Orthopaedic Sur-
those patients in whom the soft nucleus travels into the gery. At the University of Southern California-Los Ange-
spinal canal and impacts upon one of the spinal nerves, les Medical Center he was awarded the Marshall Schiff
sciatica predominates. Those patients with less impact on Award and Herman Epstein Award. Dr. Wijesekera spe-
the spinal nerves often experience more back pain. cialized in Spinal Surgery at the University of California
Davis Medical Center, where he completed fellowship
The diagnosis of a herniated disc can often be suspected training in all aspects of adult and pediatric spinal sur-
from a simple description of a patients symptoms and a gery.
physical examination. An MRI scan can often provide
radiographic evidence to support your doctors’ suspicion He has joined the Orthopaedic Group, LLC in New Ha-
of a herniated disc. Once your doctor has made the diag- ven, Connecticut, and brings spinal surgery expertise to a
nosis a variety of treatment options are available to you. well-rounded and equipped practice of orthopaedic sur-
geons.
Many conservative options exist, including observation,
medications, and physical therapy. The vast majority, Dr.Wijesekera completed the first artificial disc replace-
more than 80% of those with a herniated disc will have ment ever performed at the Hospital of St.Raphael.
© 2008 The Orthopaedic Group, LLC Not to be reproduced without the express permission of the author