Herniated disc of the cervical spine and herniated disc of the lumbar spine will occasionally need surgery. Most often, the indication for the surgery is constant pain, numbness or tingling in an arm or leg. Here's an interesting fact: 90% of the herniated discs diagnosed by MRI get better on their own and don't require surgery!
There are some urgent situations that people with herniated disc of the cervical or lumbar spine should be aware of. If a patient should develop progressive numbness, progressive weakness, bowel or bladder loss of control, or inability to ambulate, then they need to contact their physician immediately or go to the emergency room right away. These situations arise very rarely, but are considered emergent indications for surgery. Fortunately, most patients do not have such extreme symptoms. By far, the majority of people receiving surgery do so because of unremitting pain.
Tuesday, April 13, 2010
Monday, April 5, 2010
DO I NEED AN MRI, CAT SCAN, OR X-RAY FOR MY BACK PAIN?
Patients with back pain often insist on obtaining an MRI, even when we think it is not necessary. When this happens, we try to educate the patient as to the proper use of x-rays and MRIs. Frequently we are able to convince the patient that the study may be inappropriate.
Our explanation is the following: An x-ray is an excellent study to look at the bones in the back, but does not really look at the nerves or the discs. The MRI is an excellent study to look at the discs and the nerves in the back, but does not look at the bone the same way an x-ray does. We use an x-ray when we are concerned about conditions involving the bones such as a fracture. An”x-ray” can be either the standard form or the CT form. CT’s are more detailed and are not usually the first line in the diagnostic work up.
It should be noted that most patients with low back pain or neck pain get better on their own without any interventional treatments, but this may take a period of six weeks. Therefore, it is not wise to rush into taking an x-ray of the cervical or lumbar spine unless back pain has been present for more than six weeks or unless there has been severe unremitting pain worsening day-by-day or history of trauma or other illness.
As mentioned, MRI’s are useful for checking to see if there is any nerve impingement. This test is typically ordered if the patient has pain, numbness, tingling, or weakness into either an arm or leg. The MRI is an excellent test to check for diseases such as herniated disc, disc degeneration, tumors, spinal stenosis and spondylolisthesis. If a herniated cervical disc or a herniated lumbar disc is suspected and pain is persistent an MRI may be ordered.
Our explanation is the following: An x-ray is an excellent study to look at the bones in the back, but does not really look at the nerves or the discs. The MRI is an excellent study to look at the discs and the nerves in the back, but does not look at the bone the same way an x-ray does. We use an x-ray when we are concerned about conditions involving the bones such as a fracture. An”x-ray” can be either the standard form or the CT form. CT’s are more detailed and are not usually the first line in the diagnostic work up.
It should be noted that most patients with low back pain or neck pain get better on their own without any interventional treatments, but this may take a period of six weeks. Therefore, it is not wise to rush into taking an x-ray of the cervical or lumbar spine unless back pain has been present for more than six weeks or unless there has been severe unremitting pain worsening day-by-day or history of trauma or other illness.
As mentioned, MRI’s are useful for checking to see if there is any nerve impingement. This test is typically ordered if the patient has pain, numbness, tingling, or weakness into either an arm or leg. The MRI is an excellent test to check for diseases such as herniated disc, disc degeneration, tumors, spinal stenosis and spondylolisthesis. If a herniated cervical disc or a herniated lumbar disc is suspected and pain is persistent an MRI may be ordered.
Wednesday, March 24, 2010
Remember—Most Herniated Discs Get Better!
It comes as a great surprise to many people to learn that 90% of all patients who have been diagnosed with a herniated disc get better on their own, without the need for surgery.
I always remind patients that the body wants to heal itself and is successful in doing so in the majority of cases. If you have symptoms for less than 4 weeks don’t give up on the hope that you will get better with time. In most cases, our bodies are able to do this without the need for an invasive procedure such as surgery.
How this actually happens is somewhat debatable, but most specialists in the field recognize that even a large herniated disc has the capacity to shrink in size and even resorb completely over a period of time. Along with the shrinking of the disc, the pain, numbness, tingling, or weakness may also resolve. For those patients lucky enough to have that occur, a surgery such as the anterior cervical discectomy and fusion will be out of the question. For the 10% or so of patients who do not get better over a period of time, surgery may be suggested.
Remember, the time period to get better is typically 6 weeks. 50% of patients are better within three weeks and 90% of patients are better by six weeks.
If your symptoms of pain related to a herniated disc in either the cervical spine or lumbar spine persist for more than six weeks, you may be a surgical candidate.
I always remind patients that the body wants to heal itself and is successful in doing so in the majority of cases. If you have symptoms for less than 4 weeks don’t give up on the hope that you will get better with time. In most cases, our bodies are able to do this without the need for an invasive procedure such as surgery.
How this actually happens is somewhat debatable, but most specialists in the field recognize that even a large herniated disc has the capacity to shrink in size and even resorb completely over a period of time. Along with the shrinking of the disc, the pain, numbness, tingling, or weakness may also resolve. For those patients lucky enough to have that occur, a surgery such as the anterior cervical discectomy and fusion will be out of the question. For the 10% or so of patients who do not get better over a period of time, surgery may be suggested.
Remember, the time period to get better is typically 6 weeks. 50% of patients are better within three weeks and 90% of patients are better by six weeks.
If your symptoms of pain related to a herniated disc in either the cervical spine or lumbar spine persist for more than six weeks, you may be a surgical candidate.
Friday, March 19, 2010
HERNIATED DISC, RUPTURED DISC, BULGING DISC, SLIPPED DISC OR EXTRUDED DISCS. What’s the difference?
HERNIATED DISC, RUPTURED DISC, BULGING DISC, SLIPPED DISC OR EXTRUDED DISCS. What’s the difference?
Many patients are confused about the difference between a herniated disc and a bulging disc and I want to take this time to clarify those terms. The least severe condition is the bulging disc and most doctors will consider a bulging disc to be a normal condition. Studies have shown that over 30% of MRIs on people who have no pain at all in the neck or back will have one or several bulging discs. From a surgeon’s standpoint, most often we view a bulging disc as a problem which is non-surgical and may or may not be even associated with pain in the neck or back. The condition that is more significant is that of the herniated disc. There are several terms that also describe the herniated discs and those include ruptured disc, extruded disc, and slipped disc. These all are pretty much the same thing. Frequently these terms are used to describe the extent of the herniation. Herniations can cause pain which radiates into the arm or leg. The cervical herniated disc will frequently give pain into the arm, but may also be associated with symptoms such as numbness, tingling, and weakness. A herniated disc in the neck which is large in size may also cause direct compression on the spinal cord and lead to symptoms of what we called myelopathy. Myelopathy is an abnormality which occurs when the spinal cord is compressed and this may lead to symptoms such as loss of bowel or bladder control, spasticity while walking, as well as weakness and other deficits of coordination. Herniated disc in the lumbar spine creates symptoms such as numbness, tingling, and weakness into one or both legs. In summary, if you have found out that you have a bulging disc on an MRI then most likely this is not a surgical problem and this may not even be related to the pain you are experiencing. If you have been diagnosed with a herniated disc on an MRI scan, then you may be a surgical candidate if you are experiencing symptoms of pain, numbness, tingling, and weakness into one or more extremities.
Many patients are confused about the difference between a herniated disc and a bulging disc and I want to take this time to clarify those terms. The least severe condition is the bulging disc and most doctors will consider a bulging disc to be a normal condition. Studies have shown that over 30% of MRIs on people who have no pain at all in the neck or back will have one or several bulging discs. From a surgeon’s standpoint, most often we view a bulging disc as a problem which is non-surgical and may or may not be even associated with pain in the neck or back. The condition that is more significant is that of the herniated disc. There are several terms that also describe the herniated discs and those include ruptured disc, extruded disc, and slipped disc. These all are pretty much the same thing. Frequently these terms are used to describe the extent of the herniation. Herniations can cause pain which radiates into the arm or leg. The cervical herniated disc will frequently give pain into the arm, but may also be associated with symptoms such as numbness, tingling, and weakness. A herniated disc in the neck which is large in size may also cause direct compression on the spinal cord and lead to symptoms of what we called myelopathy. Myelopathy is an abnormality which occurs when the spinal cord is compressed and this may lead to symptoms such as loss of bowel or bladder control, spasticity while walking, as well as weakness and other deficits of coordination. Herniated disc in the lumbar spine creates symptoms such as numbness, tingling, and weakness into one or both legs. In summary, if you have found out that you have a bulging disc on an MRI then most likely this is not a surgical problem and this may not even be related to the pain you are experiencing. If you have been diagnosed with a herniated disc on an MRI scan, then you may be a surgical candidate if you are experiencing symptoms of pain, numbness, tingling, and weakness into one or more extremities.
Monday, March 1, 2010
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