Diagnostic Testing for Herniated Discs
Diagnostic TestingBack pain may have multiple causes, so a complete evaluation is necessary to diagnose a cervical, lumbar, or thoracic herniated disc. The spine experts at Och Spine at NewYork-Presbyterian may take the following steps to determine what is causing your symptoms and determine if you have a herniated disc.
- Medical history to learn about your symptoms: when did they start, what makes them feel better or worse, and how do they limit your activities? The doctor will also ask you about your family medical history and your activities.
- Physical and neurological exams to assess your range of motion, muscle strength, pain, and sensation.
- Magnetic resonance imaging (MRI) is the best imaging method to see the bones, discs, and nerves in and around your spine. It can show the nucleus protruding from the disc and pressing on a nerve.
- A myelogram is a special X-ray using dye injected into the spinal fluid to show a ruptured disc on an X-ray. After the myelogram, your doctor may order a computed tomography (CT) scan.
- Electromyogram (EMG) and nerve conduction studies (NCS) measure electrical activity in the nerves and muscles. They may identify nerve damage or nerve compression.
Herniated vs. slipped vs. bulging discs
It's not uncommon for herniated discs to be described as "slipped discs." However, this is a misnomer because the disc does not move out of its location between the vertebrae. Instead, the gel-like nucleus of the disc slips out through a tear in the disc. It may also be called a "pinched nerve" when it presses on a nerve. Bulging discs are discs whose contents are starting to push outward on the inner walls of the discs but have not yet torn. Nonsurgical treatments can be useful for treating herniated discs as well as preventing bulging discs from herniating.
Nonsurgical Treatment Options for Herniated Discs
Doctors usually try nonsurgical therapies first to treat a herniated disc and relieve symptoms. You may have one or more of these treatments.
Physical therapy
Physical therapy for a herniated disc is a common treatment approach. Physical therapists help patients learn about proper alignment of the spine and approaches to move safely while teaching ways to improve strength, posture, range of motion, and flexibility. Components of physical therapy may include exercises you learn with your therapist and do at home to stretch and strengthen your muscles. Patient education and directional preference techniques (designed to centralize your symptoms to decrease nerve pain) may be utilized as well. Your therapist will choose the exercises that are most effective for you and also tell you which movements to avoid.
Stretches and exercises
Exercises to strengthen the back and abdominal muscles are important components of physical therapy for a herniated disc. Strong abdominal muscles are vital for supporting the lower back in particular. Spinal stabilization exercises to strengthen the core trunk muscles may be used to encourage good posture with a "neutral spine."
Sometimes we are tighter on one side of the body than the other. Stretching of the neck, shoulders, upper and middle back, lumbar spine, and hips can help achieve better balance in the body and reduce uneven stress on the spine. A physical therapist can show you the kinds of exercises that are best for your herniated disc. Many people find value in practicing yoga poses that gently stretch the neck, back, hips, and hamstrings (backs of the thighs) to improve flexibility and reduce muscle strain.
Medications and injections
You may receive a prescription medication to relax the muscles and reduce inflammation around the herniated disc, or gabapentin to treat nerve pain. Another common treatment is the injection of the steroid drug cortisone directly into your spine to treat painful nerve inflammation caused by the herniated disc. This injection is performed with the guidance of medical imaging so the physician can safely insert the needle into the precise location.
Nonsurgical Treatment Options for Herniated Discs
Nonsurgical TreatmentDoctors usually try nonsurgical therapies first to treat a herniated disc and relieve symptoms. You may have one or more of these treatments.
Physical therapy
Physical therapy for a herniated disc is a common treatment approach. Physical therapists help patients learn about proper alignment of the spine and approaches to move safely while teaching ways to improve strength, posture, range of motion, and flexibility. Components of physical therapy may include exercises you learn with your therapist and do at home to stretch and strengthen your muscles. Patient education and directional preference techniques (designed to centralize your symptoms to decrease nerve pain) may be utilized as well. Your therapist will choose the exercises that are most effective for you and also tell you which movements to avoid.
Stretches and exercises
Exercises to strengthen the back and abdominal muscles are important components of physical therapy for a herniated disc. Strong abdominal muscles are vital for supporting the lower back in particular. Spinal stabilization exercises to strengthen the core trunk muscles may be used to encourage good posture with a "neutral spine."
Sometimes we are tighter on one side of the body than the other. Stretching of the neck, shoulders, upper and middle back, lumbar spine, and hips can help achieve better balance in the body and reduce uneven stress on the spine. A physical therapist can show you the kinds of exercises that are best for your herniated disc. Many people find value in practicing yoga poses that gently stretch the neck, back, hips, and hamstrings (backs of the thighs) to improve flexibility and reduce muscle strain.
Medications and injections
You may receive a prescription medication to relax the muscles and reduce inflammation around the herniated disc, or gabapentin to treat nerve pain. Another common treatment is the injection of the steroid drug cortisone directly into your spine to treat painful nerve inflammation caused by the herniated disc. This injection is performed with the guidance of medical imaging so the physician can safely insert the needle into the precise location.
Herniated Disc Surgery
SurgeryEmergency surgery may be needed if you have a large disc herniation that could damage the nerves of the bladder or bowel. Otherwise, surgery for a herniated disc is used primarily when nonsurgical treatments are not effective enough to relieve your symptoms after 6-12 weeks. Surgery for a herniated disc is best performed at a major spine center by doctors who are trained and experienced in the most up-to-date techniques.
At Och Spine, we use minimally invasive surgical approaches whenever appropriate, operating through very small incisions so your recovery can be quicker and you can get back to doing the things you enjoy sooner.
- Endoscopic discectomy. The least invasive option available, this advanced technique requires only the tiniest of incisions (7 mm, or less than a quarter of an inch). A specially trained neurosurgeon inserts a slender endoscope into the incision, and a wafer-thin camera and tools are guided to the herniation under X-ray guidance. There is no cutting into the muscle—making the procedure essentially painless—and patients may go home the same day.
- Minimally invasive microdiscectomy. Operating through a half-inch incision with X-ray guidance, the surgeon removes the bulge from the herniated portion of the disc and relieves pressure on the affected nerve. The surgeon uses a microscope to carefully remove the herniation and free the nerve. Patients are walking within a few hours of the procedure.
- Artificial disc replacement. The surgeon locates the affected disc and removes it—thereby decompressing the nerve. The disc is replaced by a synthetic disc substitute, which eventually is able to serve the function of a healthy disc.
- Spinal fusion. If other nonsurgical and surgical techniques are not options for effectively treating a herniated disc, fusing the two vertebrae together above and below the herniated disc may be needed so there is no longer any motion between them. This reduces spinal pressure, pain, nerve damage, and the risk of another herniation. Using a computerized image guidance system, the surgeon operates through small incisions and uses screws to unite the two vertebrae while avoiding injury to nearby delicate nerve tissue. Spinal fusion reduces spinal mobility in the area but is very effective for reducing discomfort.
When to See a Doctor for a Herniated Disc
When to See a DoctorIf you have symptoms of a herniated disc, you should see a doctor to determine the cause and find out if you need treatment. Your doctor is likely to prescribe at least physical therapy to help you gain strength and flexibility to treat this injury and prevent future herniated discs. If you have back pain accompanied by loss of bladder or bowel function, trouble walking or balancing, or pain radiating into your arms or legs, you should see a doctor as soon as you can.
Receive Personalized Spine Care at Och Spine at NewYork-Presbyterian
Herniated discs are one of the most painful and debilitating spinal disorders in this country and one of the leading causes of pain and disability. Their treatment requires the expertise of teams of spine specialists with the knowledge, experience, and understanding of this disorder and how it can negatively impact patients' lives.
Every doctor at Och Spine has experience in various back and neck conditions and injuries. When you call us to make an appointment, we will work with you to identify the best physician for your specific need. At NewYork-Presbyterian Och Spine , we carefully listen to you to learn about your symptoms and goals. We will customize a plan of care that meets your personal needs and gets you back to where you want to be.
Contact us today to schedule an appointment.