Herniated discs: The basics

You tried to lift a heavy box and the pain came on suddenly. Did you pull a muscle or is it possible you suffered a more serious spinal injury, like a herniated disc? We spoke with Mina Safain, MD, a neurosurgeon who sees patients at the Spine Center at Tufts Medical Center in Boston and at MelroseWakefield Healthcare in Melrose. Dr. Safain specializes in minimally invasive spinal surgeries and pain reduction techniques. He answered questions regarding when you should visit a physician, treatment options and how to avoid a herniated disk.

What is a herniated disk?

An example of a disc absorber in a spineDisks themselves do not "slip" per se. The disks are the shock absorbers of the spine and are surrounded by a thick fibrous layer.  In some people either due to a certain activity or sometimes spontaneously this thick fibrous layer gets a tear. This allows some of the softer jelly like portion of the disk to herniate out.
 A second problem is when the spine becomes loose for a variety of reasons and one of the spinal vertebrae moves compared to the adjacent vertebrae. This is termed spondylolisthesis and due to the movement can cause back pain and compression of spinal nerves. 

How is a herniated disc diagnosed?

The most common way to diagnose a herniated disk is a history and physical examination by an experienced clinician usually followed by an MRI scan of either the neck, mid spine, or low back depending on the symptoms and signs. 

When should you go to a hospital for back pain vs. at home treatments?

Back pain is quite common and most often does not require a visit to the hospital.  "Red Flag" signs that should be evaluated in a hospital setting include any sudden or new onset of weakness, severe numbness, issues with bladder or bowel control, or numbness in the genital area.  In addition, severe unrelenting pain not taken away by over the counter medication should be evaluated by your Primary Care doctor or local hospital.    

Are there preventative measures that can be taken to avoid herniating a disk?

There are multiple preventative measures that can be taken. Herniated disks can often happen with improper bending and lifting heavy objects.  The old adage of bend with your knees not with your back is a good rule to follow. When lifting heavy objects hold them close to your body, stand with a wide base and bend at the knees and not the waist. Twisting at the waist while holding a heavy object is also a common way to herniate a disc.  Maintaining an active routine of abdominal and back strengthening exercises can be a good preventative measure to avoid damage to discs.   

What are general treatment options for a herniated disc?

The majority of these injuries will heal without surgery or intervention.  The body will shrink the disk herniation over a period of a few weeks to a few months. The goal of treatment during an early period of disk herniation is to relax so your body can work to heal the disk herniation. This can be done with a combination of anti-inflammatory, steroid, and muscle spasm medication in addition to heat and ice therapy. 

If this therapy fails, injection therapy via a pain specialist expert may be an option. Finally when these therapies fail, surgical removal of the disk herniation can be done in a minimally invasive manner.

To make an appointment with Dr. Safain at the Spine Center at Tufts Medical Center in Boston, call 617-636-2266 Monday – Friday, 8am – 4:30pm. To make an appointment with Dr. Safain in Melrose, call 781-979-3070. 

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