Diagnosis

There are several parts of an examination when a disc herniation is suspected.  Customarily, every examination will be begin with your doctor reviewing your medical history.  This begins the process of ruling-in and ruling-out several competing disorders that could give rise to a the back pain, sciatica, numbness, tingling, and weakness commonly associated with lumbar disc herniation.  You doctor will then begin the subjective assessment process.  This is where your doctor will take an inventory of your complaints.  Questions regarding the length of injury, how the injury occurred, what makes the complaints better and worse, as well as other queries are often asked to assist in the examination process.  A series of objective tests will complete the examination process.  Measures of flexibility, strength, and reflexes as well as an assessment of posture, gait, and tenderness are all necessary pieces to complete the clinical picture in a majority of cases.

Usually, your medical history and a physical examination are all the doctor needs to diagnose a herniated disk. In case they think you have another condition or want to see the affected nerves, they may order imaging tests or nerve tests.

Imaging tests include the following.

  • X-rays are only used to check for other tumors, infections, fractures, and spinal misalignment among other causes of back pain. X-rays don’t reveal herniated disks.
  • Computerized tomography (CT scan) uses multiple x-rays from a variety of directions to generate a cross-sectional image of the spine and surrounding structures.
  • Magnetic resonance imaging (MRI) uses a powerful magnetic field and radio waves to generate an image of your body’s interior. An MRI identifies the site of a herniated disk as well as the affected nerves.
  • Myelograms involve injecting a dye into the spinal fluid. X-rays are then taken to identify pressure areas on your spine and nerves resulting from multiple herniated disks or other causes.

Nerve tests include electromyograms and nerve conduction studies that follow the movement of electrical impulses along nerve tissue to determine which nerves are damaged.

Treatment

Most people recover after a few days to weeks of receiving conservative treatment. This treatment involves avoiding painful positions, using pain medication, and adhering to a prescribed exercise program.

Medications include the following.

  • Over-the-counter (OTC) anti-inflammatories / pain medication. Your doctor may recommend the OTC medications like naproxen (e.g., Aleve) and ibuprofen (e.g., Motrin and Advil) for mild to moderate pain.
  • Narcotics. Your doctor may prescribe opioids (e.g., hydrocodone and codeine) or an oxycodone-acetaminophen combination (e.g., OcyContin and Percocet) for a brief period if OTC medications fail to improve your symptoms. These drugs have side effects including nausea, sedation, constipation, and confusion among others.
  • Anticonvulsants. Medications initially used to manage seizures can alleviate the radiating nerve pains that typically results from herniated disks.
  • Muscle relaxers are used to treat muscle spasms. These drugs have side effects such as dizziness and sedation.
  • Cortisone injections. Doctors may inject corticosteroids directly into the areas surrounding the damaged nerves to suppress inflammation. Spinal imaging is used to maneuver the needle safely to reduce inflammation and swelling. Oral steroids can also be useful.

Your doctor may suggest therapy after a few weeks if you still experience pain. Physical therapy helps you manage the pain from your herniated disk by teaching you the pain-free positions and taking you through an exercise program customized to help you reduce the herniated or bulging disc material back into place.

If the pain persists after six weeks of conservative treatment, you may be among part of the small minority of people who need surgery to treat their herniated disks. Surgery is more common if you experience severe symptoms such as

  • Weakness or numbness
  • Difficulty in walking or even standing
  • Uncontrollable bowels and bladder

Surgeons typically remove the distended part of the disk. They don’t usually take out the whole disk unless necessary. The surgeons may use metal hardware to fuse vertebrae and stabilize the spine. In some occasions, they may insert an artificial disk.

Complementary and alternative medicine (CAM) such as acupuncture, chiropractic, yoga, and massage therapy can help relieve chronic back pain. So can lifestyle and home remedies such as heat or cold packs and avoiding too much bed rest which weakens muscles and stiffens joints.

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