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Herniated Disc/Radiculopathy

In the spine, there is a “cushion” between the individual bones that make up the spinal column. These “cushions” are called intervertebral discs because they sit in between the vertebral bones. Often the discs are compared to a “jelly donut” with a tough outer casing and a softer inner “gel” called the nucleus pulposus. If a disc is placed under significant physical stress, the inner gel can sometimes push out (herniate) through an opening in the tougher outer exterior. This condition has also been called a “slipped” or “ruptured” disc.

Herniated discs/radiculopathy can occur in the upper (cervical), middle (thoracic) and lower (lumbar) portions of the spine. If this disc herniation is in close proximity to and contacts or compresses the spinal nerves descending within the adjacent spinal canal, these nerves can become inflamed. It is important to note that not all herniated discs cause pain.

Symptoms

If a herniated disc is causing symptoms in the cervical spine (neck), patients typically describe severe neck pain that travels into the shoulder, scapula, arm, forearm and hand. There may be associated symptoms such as numbness, tingling, or a sensation of weakness or clumsiness. Occasionally, there may be actual weakness of the arm.

In the thoracic spine (mid-back), patients typically describe mid-back pain that travels to the front of the chest or upper abdomen. Again, there may be numbness, tingling or a sensation of weakness.

If the lumbar spine (lower back), you may experience low-back pain that travels down the buttock or groin and into the legs and feet. There can also be numbness, tingling, or a sensation of weakness. Occasionally, there may be actual weakness of the legs. Bowel or bladder incontinence and numbness in the perineal area are signs of a serious neurological condition called cauda equina syndrome. The cauda equine is a collection of nerves at the lower end of the spinal cord that can be compressed by a severe disc herniation, trauma, tumor, spinal stenosis or inflammation. Diagnosis is typically confirmed by MRI or CT scan, and emergent surgery may be required. 

With any herniated disc pain, sometimes coughing, sneezing, straining and moving the affected extremity can make the pain worse.

Possible Causes

As we age, the gel inside our intervertebral discs loses its water content, and the discs can start to degenerate. Typically these compromised, degenerated discs are more susceptible to the gel inside herniating through the outer casing. Many times there is no well-defined event which causes the gel inside to herniate. Possible causes do include trauma, lifting, falls, whiplash, a previous history of herniated discs, or a previous spine surgery. Some populations are at greater risk for herniated discs, including patients who are overweight, have strenuous physical jobs, or who have a family history of chronic spine pain.

Treatment

Your JLR Center for Pain Medicine physician will work with you to determine the best treatment plan for your unique case. Possible treatments range from non-invasive therapy such as physical therapy and medication to minimally invasive options such as an epidural steroid injection. These epidural steroid injections provide significant reduction in inflammation and pain. They also help localize and confirm the source of the pain, providing diagnostic information and allowing the creation of a more well-defined and accurate long-term plan of treatment. If a patient has failed conservative, non-surgical options, it is reasonable to consider surgical intervention.