Herniated Disc Treatment in New Jersey

Symptoms of Herniated Discs

Herniated discs most commonly occur in the neck (cervical spine) and low back (lumbar spine). They only cause symptoms if they impinge on nearby nerves with symptoms including:

Cervical (neck):

• Pain radiation into the upper trap, arm, hand, and shoulder blade. Pain is often described as shooting, burning, and severe. Pain can be constant or fluctuate with prolonged positioning, activity, and repetitive movements.
• Numbness and tingling into the arm or shoulder blade region. Numbness is often described as a painful pins and needles in the arm and hand.
• Weakness may present in the arm or hand. Sometimes there is obvious difficulty with elevating the arm or grip strength. Fine motor skills may also be compromised (difficulty with writing or buttoning a shirt).

Lumbar (low back):

• Pain radiation into the buttock, groin, thigh, calf, or foot. Pain is often described as shooting, burning, and severe. Pain can be constant or fluctuate with prolonged positioning, transitional movements, and repetitive movements.
• Numbness and tingling into the buttock, thigh, calf, and foot. Some patients may have numbness without tingling, or tingling without numbness, or both simultaneously. Numbness is often described as a painful numbness in the leg or buttock.
• Weakness in the leg may present in different parts of the leg. One of the more common presentations is a symptom called “drop foot” which occurs when pressure is placed on the motor portion of the L5 nerve root. This nerve innervates the muscles of the leg which bring the foot upward when walking. When this nerve is affected the foot often slaps against the ground because the pinched nerve can’t send proper signals to the muscles which lift the foot upward. Weakness may also present in loss of balance and coordination with walking.

Causes of Herniated Discs

A normal intervertebral disc has a soft, spongy core (nucleus pulposis) that allows the disc to act as a shock absorber. This soft core is surrounded by a tough outer capsule (annulus fibrosis) that tightly contains the soft core and binds the vertebral bodies together. If the outer capsule develops tears or holes, material from the soft core can get squeezed out. When this happens, it is called a disc herniation.

There are many reasons this happens, but the most common is age-related wear and tear on the disc over time. This process, known as degenerative disc disease, is a natural part of aging, and very similar to the wear and tear suffered by other joints in the body, such as knees and hips. A degenerated disc can develop an annulus tear just as a degenerated knee can develop a meniscus tear.

If a tear develops in the annulus, or outer capsule of the disc, it may not take much pressure to push out soft material from within the nucleus pulposis. Sometimes, a simple movement will do it, such as bending over to put on socks. However, a more forceful event, such as fall or motor vehicle accident, can cause a herniated disc even in a younger, healthier disc.

Material can encroach upon and irritate nearby nerves of the spinal column, causing a wide range of symptoms including pain, numbness, tingling, and weakness wherever the affected nerves go, typically to the arms and legs.

Risk Factors

• Age: Injuries are more common as we accumulate the effects of age-related wear and tear on the annular fibers of the disc.
• Obesity: Increase body mass places increased stress on the intervertebral discs. This in turn increases the daily wear and tear on these discs.
• Occupation: Careers that require heavy work including repetitive lifting, twisting, pushing, and pulling unfortunately put these workers at higher risk of herniated discs from accelerated wear and tear.
• Smoking: Smoking decreases the oxygen supply to the body, including the discs. Decreased oxygen leads to decreased regenerative ability – smokers’ discs age faster as a result.

Diagnosis of a Herniated Disc

Through a detailed history and exam, your doctor can distinguish whether your symptoms are caused by a herniated disc or by inflammation of nearby joints such as the shoulder, hip, or sacroiliac joint, or even by impingement of a nerve outside of the spinal column. The cause of symptoms can NEVER be diagnosed from an MRI alone. The exam typically includes:

• Range of motion test: Assessing how far you can move your spine in each direction and which movements cause pain or electrical sensations.
• Neurological assessment: A group of tests that evaluates your nervous system to localize where your symptoms are originating. This assessment includes testing:
  • Strength in the individual muscles of the arms and legs
  • Coordination and fine movements
  • Reflexes
  • Walking and balance
  • Sensation to light touch and pin prick
• Palpation: Touching, pushing, and squeezing of muscles and other structures to determine alignment, spasms, and provoked sensations.

Depending on what your doctor finds on your exam he or she may make a diagnosis of lumbar herniated disc. If necessary, your doctor may order further testing to refine the diagnosis.

• X-ray: An image of the bones in your spine. An x-ray can locate arthritic changes in the vertebrae, including the location and severity of bone spurs. Load bearing X-rays can also be used to assess abnormal bone alignment, which may contribute to your symptoms.
• MRI (magnetic resonance imaging): An image of the soft tissues of the spine, which cannot be seen on X-ray. Most commonly an MRI will be ordered for the physician to locate the exact level of the herniated disc. MRI can also locate tumors, cysts, or loose ligaments in the spine impinging on nerves, causing symptoms identical to a herniated disc.
• Electromyography (EMG): An EMG measures the activity of the muscles at rest and during contraction, determining the communication of the nerve to the muscle. In an EMG test, needles are used in addition to electrodes. This study helps evaluate the extent of possible nerve damage involved in your symptoms.