Ask An Expert: Herniated Disk

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Ask An Expert: Herniated Disk

Question:

Are there any alternatives to back surgery when a disk is herniated into the spinal cord?

Answer:

The spinal cord is protected by the bones of the spine. These bones are called vertebrae, and they are stacked vertically from the neck to the lower back. Discs are located between the vertebrae and serve as spacers and shock absorbers. They can bulge or tear, most commonly due to age-related degeneration or injury. In these situations, the disc extends outward from its normal location, and may press on a nerve or the spinal cord. Commonly called a "slipped disc," symptoms include pain and numbness or tingling that radiates into the arms or legs. Weakness in a limb may also complicate disc disease.

The most common locations for disc problems are in the neck or lower back. Your doctor can usually diagnose disc disease based on a combination of your symptoms, examination findings and imaging tests such as MRI.

Most disc disease does not require surgery. Common treatments include:

• Applying heat or cold (whichever feels better)

• Rest, balanced with gentle stretching exercises

• Neck collar (for disc disease in the neck)

• Massage

• Acupuncture

• Medications

  • Pain relievers, such as acetaminophen

  • Anti-inflammatory medicines, including ibuprofen or naproxen

  • Muscle relaxants, such as carisoprodol or cyclobenzaprine

  • Medicines for nerve pain, such as gabapentin or amitriptyline

  • Injections to interrupt pain signals from nerves (called "nerve blocks")

In some cases, surgery is the only treatment that works. However, it is generally considered a treatment of last resort. During surgery, surgeons remove the herniated disc material to reduce pressure on the spinal cord and nearby nerves.

Keep in mind that many people have abnormalities on MRI of the spine, including slipped discs, but don't have any pain. Because minor abnormalities may not cause symptoms, it is important to be as certain as possible that it is the disc that is causing pain before having surgery. That's one reason I often recommend a second opinion when surgery is being considered for disc disease.

In many cases, the need for surgery is clear-cut. For example, when other treatments fail and the location and severity of the disc problem is clearly responsible for ongoing symptoms, surgery is worth serious consideration. However, when back surgery for disc disease fails, it is often because the bulging disc wasn't the source of pain in the first place.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Last updated:	June 09, 2007