A herniated disc is a displaced fragment of nucleus pushed out through a tear in the outer layer of the disc, called the annulus. A portion of the nucleus isolated from the rest of the disc will out into the canal. This situation responds the best to surgery. It may not respond to conservative therapy, including manipulation and even chemonucleolysis.
Typically, a herniated disc is preceded by one or more episodes of low back pain. When the nucleus actually herniates, it compresses the spinal nerves and the pain typically changes from back pain to sciatica. Sciatica is a pain which radiates from the lower back down through the leg, into the foot in a characteristic pattern, depending upon the spinal nerve affected. There also may be resulting leg muscle weakness and knee or ankle reflex loss.
A CT scan or an MRI of the lumbar spine area is usually performed, demonstrating the degree of disc degeneration at the herniated level, the condition of other lumbar discs and the size of the spinal canal.
The initial treatment for a herniated disc is usually conservative, i.e. nonoperative. One usually begins with resting the low back area, aided by non-steroidal anti-inflammatory medication, muscle relaxing medications, pain killers, one or more epidural steroid injections, and physical therapy. If these conservative treatments are not successful, if the pain is still severe or if muscle weakness is increasing, then surgery is necessary.
The most commonly performed procedure is microdiscectomy. The sciatic pain down the leg should be resolved after surgery. However, there will be some discomfort in the low back area where the operation is performed, lasting several days to a couple of weeks.
After a successful laminotomy and discectomy, 80-85% of patients do well and are able to return to work. A person who has sustained one disc herniation is statistically at increased risk for experiencing another. There is an approximate 5% rate of recurrent disc herniation at the same level, and a lesser incidence of new disc herniation at another level. Factors involved may be weight related level of physical conditioning, work or behavioral habits. Unfortunately, approximately 5% of patients with herniated, degenerated discs will go on to experience symptomatic or severe and incapacitating low back pain which significantly affects their life activities and work. This unfortunate result is not always specifically the result of surgery. When this occurs, the prognosis is poor for returning to normal life activities regardless of age.
Generally, we recommend to patients suffering from low back pain or disc herniation to follow the counselling of a Low Back School.