Herniated Disc

What is a herniated disc?

The spine is made of bones, nerves, and a soft, gel-like cushion that sits between each vertebra, called a disc. The discs in the spine help absorb pressure and keep the bones from rubbing against each other. These discs are made up of a soft center called the nucleus, which is encased in a tough, rubbery exterior called the annulus. The term “herniated disc” refers to a problem with one of these cushioning discs in the spine where the nucleus has pushed out, through a tear in the annulus. Doctor Brenton Pennicooke, herniated disc specialist, treats patients in Saint Louis, Creve Coeur, and surrounding cities in St. Louis County, Missouri who are experiencing symptoms associated with herniated discs.

What causes a disc to herniate?

Many causes can contribute to a herniated disc, but the most common is an age-related wear-and-tear condition called disc degeneration. As individuals age, the discs in the spine become less flexible and more susceptible to tearing or rupturing. Other causes of a herniated disc could include:

• An accident that causes too much stress on the disc, such as an automobile accident or falling from a height.
• Sudden twisting or jerking that puts stress on the disc.
• Medical conditions such as spinal stenosis
• Improper lifting technique

Are there different severities of a herniated disc?

Dr. Pennicooke divides disc herniation into four stages:

• Stage 1, Bulging: A flattening of the disc in all directions. Cracks may be present in the annulus, but nothing has torn.
• Stage 2, Protrusion: The nucleus has bulged to the outer part of the fibrosus ring of the annulus, but the annulus is still intact.
• Stage 3, Extrusion: The nucleus has bulged out of the fibrosus ring. This is the herniated stage.
• Stage 4, Sequestration or Free Fragment: This occurs when pieces of the nucleus have fragmented or broken free from the disc and have moved into the spinal canal.

What are the symptoms of a herniated disc?

A herniated disc can occur anywhere in the spine, but is most commonly seen in the lumbar spine, or lower back. The symptoms of a herniated disc depend on where they are located in the spine, and which nerves the protrusion presses upon. In general, herniated disc symptoms include:

• Pain
• Weakness in the back and extremities
• Numbness and tingling

How do I know if I have a herniated disc?

Not all herniated discs have symptoms, however if you are experiencing neck or back pain, numbness or tingling that radiates to your arms or legs, it is time to see a specialist. Dr. Pennicooke will obtain a thorough history and inquire about the patient’s symptoms. An MRI is the best diagnostic tool for visualizing the condition of the discs between the spine. Doctor Pennicooke will assess the discs, bones and the affected nerves. Other diagnostic tests may include a CT Scan, x-rays, or nerve conduction study. 

What is the treatment for herniated disc? 

Non-Surgical:

Most herniated discs do not require surgery and symptoms can be managed non-surgically. Dr. Pennicooke may recommend:

• NSAIDs: Non-Steroidal Anti-Inflammatory Drugs to reduce swelling and manage painful symptoms.
• Muscle relaxers: Help with muscle spasms
• Neuropathic drugs: Affect nerve impulses to decrease pain
• Cortisone Injections: Injected into the area around the spinal nerves to alleviate pain and help healing.
• Physical therapy
• Rest

Surgical:

If non-surgical treatments fail to alleviate the symptoms of a herniated disc, or if your symptoms worsen, surgical intervention may be necessary. Depending on the location and severity of the herniated disc, Dr. Pennicooke may perform one or more of the following treatments:

• Microdiscectomy: Removes the protruding portion of the damaged disc.
• Discectomy and Fusion: Removes the damaged disc and fuses the two-remaining vertebra.
• Artificial Disc Replacement (for cervical herniated discs)