Herniated Disc Treatment Options

A herniated disc is a condition where the cushioning disc between the vertebrae is damaged by wear and tear, injury or aging, causing the soft inner part to bulge out through the tough outer layer and pinch or irritate the nearby spinal nerves.

Symptoms vary, but can include intense pain, numbness, or weakness in the area where the nerve is affected. Depending on the location of the herniated disc, it can cause various symptoms. For instance, if it occurs in the lower back (lumbar spine), it can cause sciatica, characterized by sharp pain radiating through the buttock and down the leg. If the herniated disc is in the neck (cervical spine), it can result in pain and numbness in the arm and shoulder. If left untreated, a herniated disc can lead to nerve damage, persistent pain, and in severe cases, loss of mobility or function in the affected area.

Many cases of acute disc herniation will resolve within the first four weeks. During this time conservative treatment with rest, over the counter pain medications, and physical therapy will be recommended. Cervical collar immobilization and traction may be tried. If the patient fails to respond to conservative treatment, corticosteroid injections may be tried. If symptoms are severe or progressive the gold standard is discectomy with fusion for cervical disc herniation.

Anterior cervical discectomy and fusion (ACDF):

ACDF is a type of surgery used to treat spinal cord and nerve root compression in the cervical spine (neck). This compression can be caused by conditions such as herniated discs, degenerative disc disease, or spinal stenosis. It may be performed as an outpatient procedure.

During the surgery, the surgeon makes a small incision in the front of the neck. The muscles and other tissues are carefully moved aside to access the cervical spine. The surgeon then removes the damaged disc (or discs) that are compressing the spinal cord or nerves.

After the disc is removed, the space where the disc was located is typically filled with a bone graft. This graft can be from the patient (autograft), from a donor (allograft), or synthetic. The purpose of the graft is to encourage the bones above and below the removed disc to grow together, or fuse. This fusion stabilizes that segment of the spine.

Cervical Disc Replacement

This involves the removal of the herniated disc and replacing it with an artificial one to alleviate pain and restore mobility. It was only recently approved as an alternative to fusion because spinal fusion while safe and effective to treat pain, permanently immobilizes the spine limiting neck movements. However, it is not available for patients with facet joint disease. Speak with your Dallas Neurological and Spine surgeon.

Surgery is considered when conservative treatments fail, and the patient’s quality of life is significantly affected.

Radiofrequency nerve ablation

This is a minimally invasive procedure designed to treat low back pain originating from a symptomatic herniated disc. It is an outpatient procedure performed using fluoroscopy, a live X-ray, to guide two small needles into the damaged disc. It uses controlled levels of radiofrequency energy that generates heat. The heat disrupt nerve fibers that have grown into and around the damaged disc and are causing pain. It works by disrupting pain signals from the nerves. It is effective at treating serious pain with results that can last a year or more and can be repeated as needed.

Discectomy

This is the most common surgery for a herniated disc. It involves the removal of the damaged part of the disc to relieve pressure on the affected nerve(s). It may be performed as open surgery or minimally invasive surgery called a microdiscectomy. It may involve the removal of a small section of vertebra to access the damaged disc. A lumbar discectomy is typically an outpatient procedure. But this depends on each patient’s disabilities and medical conditions. It is very successful at eliminating low back pain and sciatica pain.

Spinal Fusion

This surgery involves fusing two or more vertebrae. The goal is to stabilize and immobilize the joint between the two vertebrae to eliminate painful movement caused by a degenerated disc. Realigning the spine and restoring disc height enlarges the space for nerves to exit the spinal canal and improve back function. There are several different surgical approaches based on the patient’s condition, and the location of the herniation.

Artificial Disc Replacement

In select cases, the degenerated disc can be replaced with an artificial disc to preserve more natural movement. This procedure is an alternative to spinal fusion for patients younger than 65 with a herniated disc in the neck.