Spine Archive: Lumbar Disk Herniation

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Should You Train Through Spine Pain?

“No pain, no gain” – aging athletes often work through pain, but is healthy? To learn more about the spine, search Dr. Anthony Leone’s Knowledge Center.

We’ve all heard this famous saying while at the gym, in movies, and from friends. But spine or back pain is a separate kind of pain – a serious pain that can mean serious complications. Athletes, especially those who are professionally training daily often force themselves to work through inflammation as they age. Certain inflammations like slight disc herniations are common and generally can be rectified with medication and conservative management. However, doctors encourage athletes to rest and to not work through the pain. Rest provides us with quicker recovery and better outcomes. Remember, your body needs exercise to strengthen the spine, but it also needs rest too. Don’t forget to take a breather!

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Lumbar Herniated Discs & Surgery

To learn more about spine surgery including microdiscectomy – contact Dr. Leone today.

When a patient is experiencing lumbar pain, sometimes surgery is an option to alleviate this pressure. A microdiscectomy is done to remove pressure from nerve roots allowing these roots the proper environment needed to heal. The good thing about this surgical procedure is that, with most cases, only small areas of the problem disc is removed – this means that the disc as a whole remains mostly intact.

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Common Causes of Lower Back Pain

Want to learn more about how lower back pain is caused and what contributes to it? Find out more here in Dr. Leone’s Knowledge Center.

In older adults the common causes of lower back pain involving the lumbar region of the spine are attributed to compression fractures or disc degeneration like osteoarthritis. In younger patients, back pain is more likely to be concentrated to the spacing between the discs via degenerative disc disease or a disc herniation. Sometimes back pain can even be the result of strains within the back muscles and other soft tissues located in or around the spine.

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Surgery in Lumbar Disc Herniations, WNY

Learn more about surgical intervention here in the Knowledge Center of Dr. Leone.

Open discectomy is the standard surgical intervention in patients with LDH whose conservative treatment has failed. Despite over 60 years of experience, the indications for surgery and the expected success rates still are reported variably. Surgical excision of the displaced disc tissue removes both the source of pressure and the initiator of the inflammatory response.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Lumbar Disc Herniations, Buffalo, New York

Contact Dr. Anthony Leone to learn more about lumber disk herniations.

Lumbar disk herniation is a self-limiting disease in most patients. Eighty percent to 90% of patients obtain satisfactory resolution of symptoms with nonsurgical treatment. Imaging studies that monitor the changes in size of nonsurgically treated disk herniations have shown a progressive decrease in the size of the herniations over time.¹

¹R. Vaccaro MD, Alexander. Orthopaedic Knowledge Update. Rosemont: American Academy of Orthopaedic Surgeons, 2005.

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Lumbar Disk Herniation

When evaluating the efficacy of nonsurgical treatment modalities for Lumbar Disk Herniation, it is important to consider that a large number of studies have focused on low back pain rather than radiculopathy as the primary symptom. One must also consider the favorable prognosis of Lumbar Disk Herniation, as approximately 90% of patients with lumbar disk herniation report improvement of symptoms. Consequently, success of the modalities used to treat lumbar disk herniation may only reflect the ability to make the patient comfortable while the natural history of lumbar disk herniation occurs and symptoms dissipate, rather than truly altering the course of the disease.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Recurrent Lumbar Disk Herniation

Recurrent herniation occurs in 5% to 11% of patients following open diskectomy. Recurrent herniation is defined as recurrent radicular pain onset following lumbar diskectomy, with evidence of neural impingement by disk material at the concurrent level. Additionally, patients must report a minimum of 6 weeks of pain relief after the index procedure. Fat-saturated, gadolinium-enhanced T1-weighted MRI is the modality of choice to evaluate recurrent disk herniation and the differentiate between and scar.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Lumbar Disk Herniation MRI

Two hundred patients with symptoms of varying severity underwent baseline MRI followed by a 5-year observation period. MRI was repeated for the 51 patients who had new, severe episodes of low back pain lasting more than 1 week. There was progression of MRI findings in 84%. The patients whose findings had progressed were mostly likely to have age-related changes such as disk height loss, facet arthrosis, or end plate changes. Only two of the 51 patients had MRI changes that were correlated with physical examination findings, and both of these patients had primary radicular symptoms. Demographic factors involving chronic pain, psychologic distress, a compensation claim, or smoking predicted the new, severe episodes of pain.¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Type of Disk Herniation

A lumbar disk herniation is defined as a local displacement of disk contents beyond the curcumferential borders of the neural elements posteriorly. A herniated disk may present as a protrusion, defined as a broad-based displacement where disk material is continuous with that of the intervertebral disk space, or extrusion, when the diameter of the disk material in the canal is greater than the distance between the edges of the base.

DiscDegeneration_labeled
Schematic of different types of disk herniations

Extrusions are termed sequestrations if no continuity exists between disk material in the spinal canal and the parent disk. Fragments can also migrate in any direction away from the site of the extrusion.

Herniations are also categorized based on location of the disk fragment in relationship to the thecal sac: central, posterolateral, foraminal, or extraforaminal. Posterolateral disk herniations commonly compress the traversing nerve root at a particular level (for example, the L5 root at the L45 level) while the foraminal and extraforaminal (far-lateral) disk fragments affect the exiting nerve root.

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¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.

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Lumbar Disk Herniation Management

Because most patients improve clinically within a 6-week period after the onset of back pain and radiculopathy, nonsurgical modalities are the initial mainstays of treatment. These include activity modification, physical therapy, anti-inflammatory medications, and epidural steroid injections. Although none of these treatments have been shown to alter the natural history of a lumbar disk herniation, they provide relief while the radicular symptoms can dissipate naturally. Most surgeons advocate for non-surgical treatment of at least 6 weeks before considering other more invasive measures.

Epidural steroid injections are a low-risk alternative to surgical treatment of lumbar disk herniation. A randomized controlled trial demonstrated that 50% of patients who received an epidural steroid injection to treat a lumbar disk herniation avoided surgical intervention. ¹

¹Garfin MD, Steven. Orthopaedic Knowledge Update : Spine. Rosemont: American Academy of Orthopaedic Surgeons, 1997.