Shirvinda Wijesekera, M.D.
We have all heard of cases of terrible back pain or sciatica. Some of these ailments can be related to a common injury to the intervertebral disc. The human intervertebral disc is a structure that lies between the vertebral bodies. It functions as a shock absorber to cushion the forces we all experience throughout the course of the day. When this disc becomes injured it can lead to a common scenario described by many names: herniated disc, slipped disc, ruptured disc, or sciatica.
The human disc has an outer layer of tough fibrous bands, much like those of a steel belted tire. These rings of tissue reinforce a soft center, the nucleus pulposis, which works as the force absorbing center. When the disc is injured the tough rings can tear, allowing the soft nucleus to extrude through the tear.
There are many grades or severities to these types of tears. On occasion this can lead to a mild bulge in the disc. At other times a complete tear can create a channel, through which the soft nucleus can travel into the spinal canal. These two components, the torn outer layer of the disc and the encroachment into the spinal canal leads to the common symptoms of back pain and sciatica. In those patients in whom the soft nucleus travels into the spinal canal and impacts upon one of the spinal nerves, sciatica predominates. Those patients with less impact on the spinal nerves often experience more back pain.
The diagnosis of a herniated disc can often be suspected from a simple description of a patients symptoms and a physical examination. An MRI scan can often provide radiographic evidence to support your doctors’ suspicion of a herniated disc. Once your doctor has made the diagnosis a variety of treatment options are available to you.
Many conservative options exist, including observation, medications, and physical therapy. The vast majority, more than 80% of those with a herniated disc will have their symptoms abate with these conservative measures. Most of those patients will have their symptoms considerably improve within 3 months or less.
In the smaller subset of patients that do not improve with conservative care or have worsening neurological examination, surgical treatment is often possible. These microsurgical techniques can result in patients going home with a minimal scar, and a rapid recovery. The techniques that past generations have had to endure have changed. New techniques, have led to better outcomes with much less morbidity. Ultimately, your doctor can provide you with a treatment regimen to return you to a normal life.
© 2008 The Orthopaedic Group, LLC Not to be reproduced without the express permission of the author
By Shirvinda Wijesekera, M.D.
Back pain can arise for a variety of reasons. People often describe their pain as an aching, tight spasm type pain that will not relent despite rest, massage, or medication. Others describe their pain as a sharp, tearing pain that can be worse with a simple cough. Yet others, experience burning, electrical pain down the legs or simply an aching in the buttocks. Why would your back pain differ from someone else's? To answer we must get the source of the back pain.
The muscles that control our spine are long strong muscles that begin at the base of the skull and travel toward our tailbone. They are remarkable in their ability to adapt and protect us from injury. When we injure a segment in our spine, the muscles of our back work hard to restrict motion to the injured segment while we heal the damage. Generally, the injury heals and the back pain dissipates over time. Unforunately, on occasion the injury does not heal quickly and the muscles begin to fatigue under constant pressure to restrict motion. The muscle can give rise to painful spasms, unrelenting aching pain, and a loss of mobility.
Often times, the injured area in the spine is the disc, or the cusion between the vertebrae or bones of the spine. This disc has a soft spongy center that absorbs the forces life delivers to our spine. Surrounding the spongy center are rings of tissue that reinforce the disc. When the disc becomes injured, these rings of tissue tear leading to a decrease in the effectiveness of the disc. During these times of injury, the spongy center often loses some of its shock absorbing properties. When the disc is injured, we may experience this as a tearing pain that can be worse with coughing, sneezing, or bearing down.
If the injury to the disc is severe, the disc can lose its round shape. As the reinforcing fibers tear, the central spongy center can expand through these tears like a bulge on a damaged tire. The reinforcing fibers can tear completely allowing the spongy center to escape from the disc and travel outside its designed location. as the displaced center or bulge moves it can pinch the nerves that travel directly behind the disc and vertebral body. This pinching can lead to an electrical or burning pain, often described as sciatica. Sciatica has a variety of presentations. Some experience the classic pain that shoots down the leg like a bolt of electricity. Others may have aching in the buttock or weakness in a leg with activity. In fact some simply have buttock or leg pain, with no back pain.
Bone spurs can also cause back pain and lead to both the ache of the muscles and the pinching of the nerves. Bone spurs are Mother Nature's answer to a painful area in the spine. As an irritated area of the spine moves, it can cause symptoms. Nature's answer to pain is the bone spur, which limits the motion in the spine. The bone spurs can lead to pinched nerves, if they develop near the nerves in the spine. They also lead to arthritic back pain.
After your doctor makes the correct diagnosis causing your back pain, you both can decide on what treatment is appropriate for your condition. Physical therapy, medications or cortisone shots, and braces are all options to combat the back pain. The goal with all of these modalities is to allow our body to function and heal itself. Spinal surgery is not always an answer or option. Surgery can be thought of as a tool that must be applied to the correct problem. When modern spinal surgical techniques are applied correctly the results can be dramatic and life-changing. The surgeries of the past have been replaced with new innovative techniques that bring the advances of minimally invasive approaches, modern technology, and faster recoveries.