Herniated Disc: Diagnosis and Treatment

With your interest in this segment of disc prolapse, I assume that you are through with what herniated disc is, what causes it and how it represents itself in a person. Now let’s look diligently into its Diagnosis and Treatment Options.

Diagnosis:

• Verbal Questions: The doctor will ask for symptoms and location
• Physical Examination of the site for redness or inflammation

1. Reflex Testing
2. Straight Leg Raise: In lying leg is raised and an increased pain confirms the diagnosis
3. Another series of physical test for the same

• Blood Test to confirm inflammation
• X-Ray to rule out other causes of backache. It shows wear and tear and its metabolites the osteophytes.
• MRI/CT scan shows properly the level of disc herniation
• A Myelogram with a dye in the spinal column for color contrast scans
• Electromyogram is helpful to determine the muscle involved
• Nerve conduction velocity test determines the nerves involved

Treatment:

• Physiotherapy based on the type of disc protrusion. Flexor/Extensor regimen as required.
• Electrotherapeutic modalities like TENS are highly pain-relieving in the case of radiating pain.
• Postural Modification
• Contrast Bath: Alternating Heat and Ice
• Collar or belt for support
• Acupuncture and Chiropractic Treatments

Medication Management:

1. Pain Killers – Over the counter pain meds
2. Anti-Inflammatory drugs – NSAIDs and Steroids
3. Needle guided Cortisone Injection
4. Muscle Relaxants
5. Opioids

The professionals you may have to consult includes:

1. A Physiotherapist
2. A Neurologist
3. An Orthopaedician
4. A Neuro Surgeon

• Surgical Management:

1. Microdiscectomy – Part of the disc is removed.
2. Fusion – The Degenerated vertebrae are fused together with a bone graft. It is an ancient form of surgery that stops the disease from progressing but limits the spinal movement. Therefore this surgery is no more recommended.
3. Disc Replacement – As other replacements, one or many degenerated discs are removed and replaced by artificial discs that are almost the same in function as the natural disc.
4. Lumbar Stabilization – A flexible and strong titanium device is inserted between vertebras that relieve pain and provide support along with preserving movement.

Prevention:

Prevention is very necessary for the people carrying out active to very active lifestyles, especially sportspeople and heavyweight carriers. There is a correct way to perform a specific heavy activity, which we will discuss here.

1. Exercise: back strengthening exercises Simple isometric exercises for abdominals and back have no contraindications.
2. Postural Advice: while sitting for long hours keep your back straight. Take breaks every 2 hours, take a stroll and continue. Keep heavy loads close to your body. While lifting from the ground, sit close to weight rather than bending from the back. While performing a machine pull-down make sure to keep your back stable and straight, so in the rest of the dumbbells or bodyweight training exercises.
3. Weight Control: It is really good to keep in shape. Make sure you eat your dinner early and do not consume excessive water right after your meal.
4. Quit Smoking: Say no to all other tobacco products too.

What you can do?

Find yourself a specialist. You may be asked any of the following questions:

• When did symptoms start?
• Mechanism of Injury?
• The extent of pain from a scale of 1 to 10?
• Anything aggravating or improve your symptoms?
• Medications or supplements do you take?
• Do you smoke?
• Does the pain radiate into your arms or legs?
• Do you sense weakness or numbness in your arms or legs?
• Does your leg pain aggravate from coughing or sneezing?
• Does it hurt while sleeping or resting too?
• Lifestyle?
• Work habits?
• Change in your weight generally or localized?

Dr. Anurag Saxena, Senior Consultant Neurosurgery, Spine Surgery, Narayana Superspeciality Hospital, Gurugram.