Herniated Disc: Diagnosis and Treatment Options

Diagnosis typically follows these guidelines:

1. Medical History and Symptoms Inquiry

     Inquiry into medical history provides preliminary diagnostic data. The nature, location, and duration of symptoms, activities that trigger symptoms, lifestyle, and underlying diseases are all crucial in determining the most appropriate treatment options for each patient's needs.

2. Physical Examination

     The physical examination confirms the history and helps physicians determine if the patient's issues are likely caused by a herniated disc. Tests include the straight leg raising test, muscle strength testing, and sensation/numbness checks to narrow down the problem's location.

3. Radiological Imaging

• The most common test is MRI (Magnetic Resonance Imaging), which allows doctors to see the exact location of the problematic disc and nerve root compression clearly, leading to effective treatment planning.
• Another tool is the CT scan. It is highly effective for visualizing bone structures, which assists in planning complex surgeries or corrective procedures. It is often performed alongside an MRI.
• Plain X-ray is still utilized as it allows doctors to evaluate spinal instability while the patient is bending or extending, which other methods may not show as clearly.

4. Epidural Injections (ESI: Epidural steroid injection, SNRB: Selective nerve root block)

     This method serves as both a diagnostic tool and a treatment. It is often used when MRI results are ambiguous. Guided by X-ray (Fluoroscope/C-arm), physicians inject steroids to reduce inflammation. If the pain subsides, it confirms the source of the symptoms.

Treatment goals are twofold: first, symptom relief for mild cases without severe nerve compression, focusing on reducing inflammation and irritation via methods such as:

1. Anti-inflammatory Medications

     Medications like Gabapentin or Pregabalin, along with NSAIDs, help alleviate pain from nerve root inflammation. Typically, inflammation lasts 2-4 weeks and may subside naturally if further triggers are avoided.

2. Physical Therapy

• Pelvic Traction: This tightens the posterior longitudinal ligament, potentially pushing mild disc herniations back into place. It is most effective in younger patients with small herniations.
• Other Modalities: Shock wave therapy and ultrasound can be used to reduce muscle spasms caused by nerve irritation.

Indications for Herniated Disc Surgery

The second goal is treating the root cause by removing the compression through surgery. Indications include:

• Severe nerve compression (Cauda Equina Syndrome), requiring surgery within 48 hours.
• Progressive neurological deficit (increasing weakness or numbness).
• Severe muscle weakness.
• Severe pain unresponsive to medication and physical therapy.
• Symptoms persisting for more than 6 weeks.

Surgical Options for Herniated Disc

1.  Nucleoplasty & Annuloplasty

     Used for patients with discogenic back pain. High-frequency radio waves or lasers are used to dissolve inflamed tissue and deactivate small nerves causing pain.

2. Endoscopic discectomy

     A modern standard allowing for minimal incisions (approx. 1 cm). Includes Full-endoscopic and Biportal (UBE) techniques. These offer faster recovery and precision.

3. Microscopic discectomy

     The current gold standard using a microscope to enhance visibility and reduce incision size compared to traditional open surgery.

Modern surgical success rates are above 90%. The risk of paralysis is extremely low and should not be a major concern for patients.

Closing Remarks

Untreated severe compression can lead to permanent muscle weakness or chronic pain. If you experience radiating leg pain, numbness, or weakness, please seek a specialist's diagnosis.

• Call: 1512
• Back-neck Pain and Degenerative Disc Center, Ramkhamhaeng Hospital