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Herniated Disc Treatment in New Jersey

IN THE MOST basic sense, an intervertebral disc is part of each joint in your spine. It functions similar to cartilage within a knee joint, acting as a shock-absorbing unit and as well as providing flexibility to the spine. The interior of the disc (nucleus pulposis) is soft and spongy, made up of loose collagen fibers and water molecules. The exterior of the disc (annulus fibrosis) is a tough, fibrous rind that encloses the soft, gelatinous material inside.

Illustration of a Spinal Disc Herniation Compared to a Normal DiscWhen a disc herniates, pain fibers in the ruptured annulus fibrosis trigger a great deal of local pain, felt wherever the disc is located, i.e., in the neck or lower back. When treatment is needed, it is crucial to seek help from the experienced, spine specialists at Centers for Neurosurgery, Spine, & Orthopedics, which is New Jersey’s only comprehensive center for herniated disc treatment.

The incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in people in their third to the fifth decade of life, with a male to female ratio of 2:1.

What Is A Herniated Disc

A herniated disc (also called a slipped disc) results from damage to the joint that sits between the bones of the spine. When this happens, pieces from the disc’s soft interior can pop out, and impinge or irritate nearby nerves in the spinal column, resulting in pinched nerves, radiculopathy, or sciatica.

Illustration of a herniated causing a pinched nerve.Depending on location, a herniated disc can cause neck or back pain, but can also cause pain along the path of the nerve that is affected. Consequently, the pain of a herniated disc can be felt far away (in the arm or leg) rather than at the location where the herniation has occurred (neck or back).

Even though herniated discs can cause a great deal of pain or discomfort, the vast majority heal by themselves. Conservative measures such as physical therapy can speed this process along, and epidural steroid injections can help alleviate the pain until the body has healed itself. It is only in rare instances that surgery is required to prevent or reverse permanent nerve damage.

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.

Close-up of the nucleus pulposis and annulus fibrosis.

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.
 

Herniated Disc Treatment

When a herniation occurs, there can be a great deal of inflammation and associated muscle spasm. Initial care is geared towards relieving these secondary pains and includes temporary rest or activity restriction.

  • Medication Treatment:
    • Over-the-counter medications such as Advil or Motrin are effective at reducing pain caused by inflammation. Tylenol can also be used for mild to moderate symptoms.
    • A short course of oral steroids can quickly relieve inflammation pain.
    • Muscle relaxers are used to treat spasm often associated with herniated discs.
    • Opioids are used when pain symptoms are severe. Often, they are prescribed for short-term use and are only used as a last resort if other medications have not been effective.
  • Physical Therapy: Physical therapists can perform manipulations and provide you with a program of stretching and exercises to help alleviate your symptoms. Physical therapists will also teach you how to strengthen muscles in your upper back, shoulders, and neck. An underlying cause of herniated disc is muscle imbalance and weakness in the core, shoulder, and pelvic musculature, causing poor stabilization of the spine. This in turn places abnormal stress on discs, predisposing them to get injured or herniate. Physical therapy can address these underlying issues of muscle imbalance and weakness.
  • Epidural Injections: A physician performs an image-guided injection to the nerve root that is impinged and inflamed. The corticosteroid injection helps to decrease the inflammation surrounding the nerve tissue and acts like “a bucket of water thrown on the fire” to help decrease the patient’s severe pain. Typically, injections are performed as a series, and a patient can have up to three consecutively before evaluating for full efficacy of the treatment.
  • Surgery: Unfortunately, not all herniated disc symptoms can be relieved with conservative measures alone. If symptoms do not improve with physical therapy or injections, or the patient is experiencing progressive neurological impairment, surgical intervention is indicated. Surgical Intervention includes:
    • Discectomy or Microdiscectomy: Minimally invasive surgery where the herniated portion of the disc is removed, relieving pressure and inflammation around the nerve root.
    • Laminectomy: A portion of the vertebra known as the lamina, which forms a roof over the spinal canal, is removed to allow the nerve root more room to exit the spine.
    • Fusion: Invasive surgery where so much of the disc or bone is removed that the spine becomes unstable. The unstable segment needs to be rebuilt with cages, bone graft, and metal screws/rods (fusion). This is the equivalent of rebuilding a damaged knee with a new, artificial knee.

NJ’s Comprehensive Herniated Disc Team

Most herniated disc injuries occur because of degenerative changes to the spine. The vast majority are corrected with conservative treatment such as medication, epidural injections, and physical therapy. When symptoms cannot be corrected this way or are causing progressive neurological impairment, minimally invasive surgery such as a microdiscectomy or more invasive procedures such as laminectomy and spinal fusion may be necessary.

The dedicated team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how herniated discs can impact your daily life. Our team of renowned, board-certified neurosurgeons, orthopedic spine surgeons, non-surgical physicians, physiatrists, rehabilitation specialists, and doctor certified physical therapists provides patients comprehensive and coordinated care.  They will enable you to quickly resume a healthy, less painful lifestyle. CNSO offers multiple convenient locations spanning across northern New Jersey, including offices in Bergen, Passaic, Morris, Essex, Hudson, and Sussex Counties. Northern NJ patients can learn more about effectively treating herniated discs by contacting CNSO today.

NJ’s only Comprehensive Center for Herniated Discs: Available near you for evaluation, treatment, and follow up care.

The dedicated team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how neck and back problems can impact your daily life. By working with this team of renowned, board-certified neurosurgeons, orthopedic surgeons, non-surgical physicians, physiatrists, rehabilitation specialists, and certified physical therapists, you will receive comprehensive and coordinated care, so you can quickly resume a healthy, less painful lifestyle free from disability. CNSO offers multiple convenient locations spanning across northern New Jersey, including offices in Bergen, Passaic, Morris, Essex, Hudson, and Sussex Counties. Northern NJ patients can learn more about effectively treating herniated by contacting the providers at CNSO today.

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