Disc Herniation with a Pinched Nerve
There is often confusion when diagnosing neck or back pain since many refer to their discomfort as being a pinched nerve or a herniated disc. The diagnosis is often correct because the two conditions are the most common problem of the pain, but they are both different issues that just happen to occur at the same time.
Typically, a herniated disc occurs in the cervical spine (neck) and the lumbar spine (back). Disc pain tends to most often take place in the lower back (disc herniation lumbar) where most weight-bearing and movement in the spine occurs. A pinched nerve is caused by a herniated disc protrusion pressing against the nerve. In most cases, a herniated disc is not painful, it’s the leaking gel substance which it contains that pinches, inflames, and irritates the nearby nerve.
A spine is made of twenty-four bones called vertebrae, but the lumbar (lower back) bears most of the weight of the body. In between each of the five lumbar vertebrae (bones) is a disc which acts like a tough fibrous shock-absorbing pad which prevents the vertebrae from rubbing together. A disc is filled with a gel-like center and if the disc ruptures or bulges (bulging disc), the gel substance escapes and causes irritation to the spinal nerves resulting in inflammation, pressure, and pain. Some may also experience leg pain, numbness, and tingling.
The spine contains many nerves, which branch out and travel to various parts of the body. If a bulging disc herniates, it usually presses on the spinal cord or spinal nerves. These nerves pass through small areas between the vertebrae and the discs, so if a herniated disc presses into the area, it can compress (“pinch”) the nerve which results in the pain associated with the herniated disc.
What Causes A Herniated Disc?
A herniation may develop instantly or gradually over weeks or months. Many factors increase the risk such as lifestyle choices, aging, and poor posture. Obesity, inadequate nutrition and lack of regular exercise, as well as tobacco use, contribute to the condition. As the body ages, biochemical changes can cause the discs to dry out and be less capable to absorb shock from movement. Additionally, body mechanics such as incorrect lifting and twisting combined with daily wear and tear stress the lumbar spine. Rheumatoid arthritis and genetics may also contribute if a family has a history of the problem.
When to seek medical attention for a herniated disc?
It’s important to seek medical attention if one is experiencing numbness, weakness, tingling, and extreme burning, or pain. While an x-ray may be able to rule out acute fractures, usually advanced imaging techniques such as a CT or MRI scan are usually needed to determine the presence, location an extent of disc herniation. Sometimes a myelogram (injection of dye) is needed so the physician can view the problem area with more ease.
How Is Disc Herniation Treated?
Disc herniation is most often initially treated with conservative management including a trial of medication and physical therapy. Medications include anti-inflammatories, muscle relaxants or nerve pain medications. If this fails, a trial of spinal injections can be offered. “Cortisone epidural” injections are the most common injection utilized for disc herniation. This is usually performed by a trained pain physician and is done in the outpatient setting. Epidural cortisone injections include deposition of a combination of steroid with a local anesthetic under x-ray guidance into/near the area of disc herniation. Sometimes, a series of 3 injections must be performed to achieve maximal benefits.
Often and over time, the herniation will shrink, and the pain will subside and perhaps eventually disappear entirely. If patients fail to respond to conservative management and/or cortisone injections, referral to a spine surgeon may be recommended. Patients who continue to have symptoms and are not surgical candidate may be offered advanced interventional pain therapies such as spinal cord stimulation.
Valley Pain Consultant physicians have received extensive training in Pain Management, and stay current with new and up to date procedures throughout the year. To schedule an appointment, please call (480) 467-2273 or complete the contact form.