Care at CNSO – Understanding Herniated Discs


hat is an intervertebral disc in your spine, and what happens when it herniates?

In the most basic sense, an intervertebral disc is a joint that connects two bones (vertebral bodies) in your spine, similar to how a knee joint connects two bones in your leg. Discs are highly specialized, however, and do not look like other joints. 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. Together, they form a shock-absorbing unit linking vertebral bodies together and providing flexibility to the spine.

As with joints elsewhere in the body, intervertebral discs are prone to age-related wear and tear, known as arthritis. They can also be damaged by trauma or excessive loading. In either case, weakening or rupture of the tough annulus fibrosis can allow pieces of soft pulposis to push out, or herniate, resulting in a herniated disc.

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.

Herniated discs can cause a variety of symptoms, depending on the location of the disc. Most commonly, herniations occur in the cervical spine at C5-6 and C6-7, or in the lumbar spine at L4-5 and L5-S1. Thoracic herniations are uncommon.

When a disc herniates, pain fibers in the ruptured annulus fibrosis trigger a great deal of local pain, felt wherever the disc is located, ie, in the neck or lower back. In addition, if the herniated fragment hits a nearby nerve, you may experience pain, tingling, or numbness wherever that nerve travels in your body. Consequently, a cervical disc herniation can cause arm symptoms (cervical radiculopathy), and a lumbar disc herniation can cause leg pain (lumbar radiculopathy, or sciatica).

Risk factors for herniated discs are identical to risk factors for arthritis or damage to other joints in the body. Excessive or repetitive stress, trauma, obesity, and smoking are environmental risk factors. Genetics also plays an important role.

Even though symptoms from a herniated disc can be severe, a majority of patients will return to normal activity without surgery. Herniated discs tend to shrink with time, as water molecules in the herniated fragment dissipate into surrounding tissues. As this occurs, pressure comes off the affected nerve, and the torn annulus heals. Follow up MRIs, if performed, often show complete resolution of even large disc herniations.

When treatment is required, it is crucially important to seek the help of experienced, qualified spine specialists who prioritize conservative care over surgical intervention. These specialists must understand the complexities of diagnosing spine conditions, especially because very few of a patient’s complaints can be measured. Unlike temperature or blood pressure, which have upper and lower limits that can be measured and treated, pain from a herniated disc is extremely subjective. To further complicate matters, the diagnosis of symptomatic herniated disc cannot be made from X-rays or MRIs alone. Indeed, most adults have abnormal findings on MRI, but are without symptoms.

A spine specialist evaluating your herniated disc must be willing to spend a great deal of time listening to you in order to gather clues about where the pain is coming from. He or she must also ask a lot of questions: Where is the pain located and where does it travel? What type of pain is it? What brings on the pain? What positions make you feel better? Finally, he or she must conduct a detailed physical and neurological examination. It is only then that the spine specialist can make sense of a complicated MRI with many possible abnormal findings.

Up to 95% of herniated disc patients will return to normal activity without surgery. The body has a remarkable capacity for healing, and the role of your spine specialist is to guide you through this process quickly, and prevent future recurrences of symptoms.

However, for the rare patients who do need injections or surgery to regain normal function, the spine specialists must have a broad range of skills and a proven record of technical mastery to assure optimal results. You owe it to yourself to get treated by the best spine specialists in the field.

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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