Could you have a herniated disc? Treatment options for back and leg pain

Back & Neck

by Ioannis Avramis, MD

Oct 28, 2020

Muscular back pain is extremely common. In fact, eight out of 10 adults experience debilitating back or neck pain at some point in their lives. Thankfully, back pain usually gets better with time and physical rehabilitation.

However, some forms of back pain are caused by structural problems in the discs, which can cause pinching of the nerves and disc-generated pain. The disc can sustain injury either from trauma or from degeneration over time — or a combination of both. Disc problems can vary and include disc desiccation, annular tears and disc herniation.

Herniated discs are the most common cause of low back pain. If you’re experiencing back pain and wondering whether a herniated disc is the cause, here’s what you need to know.

What is a herniated disc?

The disc is a combination of soft tissue and cartilage that acts as a shock absorber between the vertebral bones of the spine. The outer annulus holds in the inner nucleus like a bag; the inner nucleus acts as the shock absorbing substance.

When a disc herniates, the inner nucleus squirts out from the annulus that contains it. The part that has squirted out can pinch on nerves and cause stenosis (narrowing of the spaces within your spine) and symptoms like back and leg pain.

Related: 5 myths people believe about low back pain

Herniated disc symptoms

The most common herniated disc symptoms people experience include a large component of leg pain, or sciatica, and a smaller component of back pain.

A disc herniation generally has a predictable pattern of symptoms. Some people will experience back pain at the instant of the herniation while most others will notice it in the next couple of days. There is generally a week of back pain with little or no leg symptoms.

After that first week, the back pain typically improves — and the leg pain begins. The leg pain symptoms are usually a burning and electrical-type pain with numbness and sometimes weakness. These leg symptoms are usually only on one side of the body but can occur in both legs. The pain is usually worse with straightening the leg and sitting down. Most people will feel less pain if they are standing, but many find it hard to stand still or walk.

Herniated disc treatment options

Although herniated discs can be painful, the good news is this: most will not require surgery, except in some severe cases.

Herniated disc treatment begins initially with non-surgical methods. The first level of treatment typically involves:

  • Non-steroidal anti-inflammatories
  • Muscle relaxants
  • Steroids
  • Nerve modulation medications
  • Physical therapy usually for about six weeks

The next level of herniated disc treatment involves an MRI and epidural steroid injection based on the results of the MRI. If a series of three injections does not control your symptoms, the last level of treatment is surgery. Depending on the severity of the herniated disc symptoms, especially if there is weakness in the leg, treatment with surgery may be expedited.

Treatment with surgery involves removing the part of the herniated disc that has been damaged and is pressing on nerves. The technical name for this procedure is discectomy or microlumbar discectomy (MLD) in the low back region.

Discectomy, which some people call “shaving the disc,” is the surgery done for a lumbar disc herniation when there are no signs of instability. Since this technique is in the lumbar spine and involves the use of a microscope, it is called microlumbar discectomy (MLD).

During this procedure, a small incision is made on the back over the level of the disc herniation. The muscle is swept aside, exposing the top of the spine bone called the lamina. A small hole is made in the lamina to visualize through a microscope the nerves and disc herniation. The disc herniation and any damaged disc material left in the disc space are removed. Most people will go home the same day.

If you’re experiencing back pain, don’t delay — find a spine expert near you.

About the Author

Ioannis Avramis, MD, is an orthopedic spine surgeon on the medical staff at Baylor University Medical Center. Book an appointment with Dr. Avramis today.

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