Sebastian Lattuga MD provides an education presentation on herniated discs. This piece gives in indepth look for patients into what a hernaited disc is, possible causes of herniated discs, diagnosis of herniated discs, treatment options for a hernaited disc, and reviews the recovery provess after surgical treatment of a herniated disc. Please feel free to call Sebastian Lattuga MD or visit his blog www.sebastianlattuga.wordpress.com for more education materials

1. +
Herniated Disc
New York Spinal Specialists
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2. + Herniated disc
 Spinal discs are the cushion-like pads located between the
.
vertebrae. Without intervertebral discs, the bones in the
spine would grind against one another.
 Discs give the spine flexibility, making movements such as
twisting, turning and bending possible. They also function
as shock absorbers. Discs protect the spine by absorbing
the impact of trauma, wear and tear, and even body weight.
 Each disc has a strong outer layer and a soft, gel-like
center. Thick fibers on the outside of the disc attach to
adjacent vertebrae and hold the disc in place.
 Herniated disc occurs when the outer layer tears or bursts Herniated discs are also
open and the gel-like center leaks into the spinal canal. referred to as “slipped” or
ruptured discs.
 Although herniated discs can occur anywhere along the
spine, they generally occur in the neck or lower back.
Patient Education

3. + Herniated disc
Herniated disc step-by-step
Nerve compression from a
herniated disc can cause:
 Nicks or holes in the outer layer
Pain | Numbness | Weakness
cause the contents of the disc to
spill out into the spinal canal.
 There isn’t room inside the canal
for anything but the spinal cord
and spinal fluid. The herniated
portion of the disc “invades” the
space, causing compression of
the nerves or spinal cord.
 The gel-like substance inside the
disc releases chemical irritants
that cause nerve inflammation and Herniated disc impinging on spinal cord/nerve roots (blue).
pain.
If a herniated disc is not pressing on a
nerve, mild pain may be the only
symptom.
Patient Education

4. + Why do people get herniated disc?
As we age, the spinal discs begin to lose fluid
volume. This is a slow process that starts around age
30. As discs dry out, microscopic cracks or tears can
form on the outer surface, causing it to become brittle
and weak.
A herniated disc occurs when the outer surface tears
or ruptures and the gel-like center leaks into the
spinal canal.
Causes of herniated disc include poor lifting habits,
repetitive movements that strain the lower back,
working with heavy machinery and injury such as a
fall or car accident. Prolonged exposure to vibration,
e.g., operating a jackhammer, can also contribute to
herniated disc.
Although herniated discs can occur anywhere along the spine, they typically
occur in the neck (cervical region) or lower back (lumbar region).
Patient Education

5. + Microtrauma
It’s normal to “blame” herniated disc on a specific
activity or singular event. While this may be true in
cases of traumatic injury, the root cause of most
herniated discs is often something quite different.
Microtrauma refers to microscopic injury to tissue or
bone. Sore muscles after a workout are an example of
“good” microtrauma. Conversely, years of heavy lifting
and strain are examples of “bad” microtrauma.
In the spine, disc damage occurs slowly and
progressively, until one day, the cumulative effects of
microtrauma cause herniated disc.
Over time, microtrauma can
Although it may seem like herniated disc is caused by cause serious injury.
a specific injury, the more likely scenario is that it is
caused by prolonged, repetitive microtrauma.
Patient Education

6. + Risk factors for herniated disc
Age; discs dry out, lose resilience
Repetitive motion, frequent heavy lifting,
wear and tear
Excessive force, e.g., falls, sports injuries
Obesity, lack of regular exercise
Smoking, poor nutrition Occupational and lifestyle factors can
increase your risk for herniated disc.
Does your job require you to sit/drive for long periods of time?
Prolonged sitting compresses the spine and increases risk.
Are you overweight?
Carrying extra weight stresses the spine and increases risk.
Patient Education

7. + Did you know?
A compressed or inflamed spinal nerve sends signals away from the spine
and out into the body. This is why symptoms such as pain, burning or
numbness are felt in your arms or legs, rather than at the location of the
herniated disc.
The severity of symptoms and where you feel
symptoms is determined by the location of the disc
and the degree of herniation.
Herniated discs occur most frequently in middle-aged adults.
Patient Education

8. + Symptoms of herniated disc
Herniated disc in the lower back:
 Mild to severe back pain
 Muscle spasm; pain may worsen with
movement
 Sciatica (pain, burning/numbness that Herniated disc in the neck:
starts in the buttock and runs down
the leg)  Pain in the neck/shoulder
 Weakness in the leg  Numbness, tingling in the
shoulder/arm
 Pain that travels down the arm
and into the hand or fingers
Symptoms can affect one, or both sides of the body
Patient Education

9. + How is herniated disc diagnosed?
Magnetic Resonance Imaging (MRI):
X-rays might be taken:
 If leg pain and other symptoms  Provides detailed images of the soft
persist after 2-4 weeks of tissues in the spine
conservative treatment
 Can show the location and severity of
 To rule out other conditions, e.g., a herniated disc
tumor, infection
Electromyography (EMG):
 May show nerve root compression;
however, EMG cannot determine the
cause of compression
Patient Education

10. + Nonsurgical treatment for herniated disc
Most patients will improve after 3-6 months
of conservative (nonsurgical) treatment.
Typical nonsurgical treatment regimen:
 Rest
 Pain/anti-inflammatory medication
 Corticosteroid injections, if appropriate
 Physical therapy
 Gradual return to normal activity
.
Herniated discs sometimes heal on their own through a process called resorption.
This means that the disc fragments are absorbed by the body.
Patient Education

11. + Surgical treatment
Most patients with herniated disc
will not need surgery.
Approximately 90% respond well
to nonsurgical treatment. If
treatment fails, or if nerve
damage and weakness worsen,
then surgery may be the best
treatment option.
The goal of surgery is to relieve
symptoms by taking pressure off
Surgery may be recommended for patients the nerve/s and spinal cord.
suffering from severe nerve compression, and/or
leg pain and weakness.
Patient Education

12. + Discectomy – surgical treatment for herniated disc
 Surgical treatment involves removing
the disc fragments that are pressing
on the nerve.
 The surgeon gains access to the
herniated disc by creating an opening
in the back of the affected vertebrae.
This part of the procedure is called a
laminotomy.
 The opening makes it possible for the
surgeon to remove the herniated disc
fragments (discectomy) and inspect
the nerve(s). Discectomy can be done as open surgery
or a minimally invasive procedure.
 Once this has been done, the incision
is closed and a dressing is applied.
Patient Education

13. + Recovery from surgery
It’s not unusual for patients to experience
relief from leg pain while still in the Recovery
Room, although it’s more likely that
symptoms will gradually subside in the
weeks following surgery.
Postoperative pain is generally mild and
controlled with pain medication.
Patients are instructed to resume activity
slowly. Sports, heavy lifting, and
bending/twisting are discouraged until
recovery is complete.
Once a disc herniates, there is a chance of it
happening again. This is referred to as
recurrent disc herniation. Fortunately, this only
affects a small percentage of patients.
Patient Education

14. + Back on track!
About 90% of patients who undergo
discectomy will obtain relief from their
symptoms.
Expect good results from your treatment, focus on
the positive, and lead a happy and productive life.
Patient Education