Disc Herniation Treatment

A herniated disc occurs when the soft, jelly-like center of a spinal disc pushes through a tear in its tougher outer layer. The spine has a series of bones (vertebrae) stretching from the base of the skull to the tailbone. Between these vertebrae are round cushions (intervertebral discs) that act as shock absorbers allowing for easy movement and flexibility. When one of these discs tears or leaks, it can lead to irritation of nearby nerves, causing pain, numbness, or weakness in the affected area. A herniated disc can occur in any part of the spine, however, it happens more often in the lower back (lumbar spine).

Herniated disc treatment in Cuba is performed by highly trained specialists in spinal care typically beginning with conservative measure with physical therapy, medication and corticosteroid injection. Should conservative treatments fail to improve symptoms spinal surgery may be an option.

Types of Herniated Discs

Herniated discs can occur in different parts of the spine and can vary in severity and type. The classification of herniated discs is often based on their location, the extent of the herniation and the direction of the herniation.

• By Location
  • Cervical Herniated Disc: The herniation occurs in the vertebrates in the uppermost section of the spinal column (C1-C7).
  • Thoracic Herniated Disc: The herniation occurs in the vertebrates in middle section of the spinal column (T1-T12).
  • Lumbar Herniated Disc: The herniation occurs in the vertebrates in the lower section of the spinal column (L1-L5).

• By Extent of Herniation
  • Protrusion: The outer layers of the disc (annulus fibrosus) remain intact, but the disc bulges outwards. The inner gel-like substance (nucleus pulposus) does not break through.
  • Prolapse: The nucleus pulposus pushes out but remains within the annulus fibrosus. The outer layer may be slightly damaged but is not completely torn.
  • Extrusion: The nucleus pulposus breaks through the annulus fibrosus but remains within the disc space.
  • Sequestration: A fragment of the nucleus pulposus breaks through the annulus fibrosus and becomes a free fragment within the spinal canal.

• By Direction of Herniation
  • Central Herniation: The disc herniates directly backward toward the spinal cord.
  • Posterolateral Herniation: The disc herniates toward the side and backward, which is the most common direction.
  • Lateral Herniation: The disc herniates directly to the side.
  • Foraminal Herniation: The disc herniates into the foramen, the opening where nerve roots exit the spinal canal.

Causes of Disc Herniation

Several factors can contribute to a disc herniation, including:

• Age-Related Wear and Tear: With age, discs naturally lose some of their water content, making them less flexible and more prone to tearing or rupturing
• Injury: Sudden trauma or injury to the spine can cause a disc to herniate.
• Repetitive Movements: Repeated heavy lifting, bending, or twisting can increase the risk of a herniated disc.
• Genetics: Some people inherit a predisposition to developing herniated discs.
• Obesity: Excess body weight puts additional stress on the discs in the lower back.
• Sedentary Lifestyle: Lack of regular physical activity can contribute to poor disc health and increase the risk of herniation.

Symptoms of Disc Herniation

• Localized and or radiating pain:
• Numbness and tingling.
• Muscle weakness.
• Increased pain with movement.
• Decreased range of motion.
• Changes in reflexes.
• Bladder or bowel dysfunction.

Diagnosis of Disc Herniation

Diagnosis for herniated disc begins with medical history review and physical examination during which previous injuries, range of motion and symptoms are reviewed. Neurological tests for reflexes, muscle strength and sensation will also be conducted. Other tests may also include:

• Imaging Tests
  • MRI (Magnetic Resonance Imaging): Detailed images of the spinal discs and nerves gives am accurate image of a herniated disc
  • CT scan (Computed Tomography): Cross-sectional images of the spine and the structures around it.
  • X-rays: Although X-ray images do not diagnosis herniated disc, they are helpful in ruling out other conditions such as fractures or bone abnormalities

• Additional Tests (if needed)
  • Myelogram: Dye injection followed by X-ray or CT scan to visualize the spinal cord and nerves
  • Electromyography (EMG): Tests electrical activity of muscles to identify nerve damage

Treatment Options for Disc Herniation

Treatment for a herniated disc usually starts with conservative methods including pain, medications muscle relaxants, narcotics, corticosteroids injections and physical therapy.

Physical Therapy

Physical therapy is an integral part of herniated disc treatment with the goal of alleviating pain, improving function, and preventing further injury.

• Electrical Stimulation: Techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) to alleviate pain.
• Manual Therapy: Gentle massage, mobilization, or manipulation to relieve pain and improve circulation.
• Stretching Exercises: Focus on improving flexibility in the spine and surrounding muscles.
• Strengthening Exercises: Core stabilization exercises to support the spine and strengthening of back extensor muscles, abdominal muscles, and leg muscles.
• Aerobic Conditioning: Low-impact cardiovascular exercises to promote overall fitness and blood flow.
• Posture and Body Mechanics Training: Maintaining proper posture during daily activities, and techniques for safe lifting, bending, and twisting to avoid further injury.
• Range of Motion Exercises: Exercises to restore normal movement in the spine and reduce stiffness.

Surgical Options

When conservative treatments fail to alleviate the symptoms of a herniated disc, surgical intervention may be considered. Surgery aims to relieve pressure on the spinal nerves or spinal cord, alleviate pain, and improve function.  Surgery maybe indicated when:

• Severe, unrelenting pain persists despite non-surgical treatments.
• Significant neurological deficits develop, such as weakness, numbness, or loss of bowel/bladder control.
• Symptoms progressively worsen.
• There is evidence of cauda equina syndrome, a serious condition affecting the bundle of nerve roots at the lower end of the spinal cord.

Surgical Options include:

• Microdiscectomy: This is a minimally invasive surgical procedure when herniated disc is compressing a spinal nerve. During the procedure, a small incision is made, and specialized instruments are used to remove the herniated portion of the disc, relieving pressure on the affected nerve.
• Laminectomy: This procedure is carried out mostly to relieve symptoms of a herniated disc that is causing spinal stenosis (the spinal canal narrows and compresses the nerves). The procedure involves removing part or all of the lamina (the back part of the vertebra covering the spinal canal) to create more space for the nerves and reduce pressure. 

• Discectomy: Discectomy is a surgical procedure that can be performed through an open procedure or minimally invasive and can involve removing the entire disc or a portion of the disc to relieve pressure on spinal nerves caused by a herniated disc.

• Spinal Fusion: This procedure is performed to treat severe cases of herniated discs, particularly when there is significant spinal instability or when multiple discs are affected. During the procedure, two or more vertebrae are permanently joined together using bone grafts, metal rods, or screws, eliminating movement between them and providing stability to the spine. This helps to alleviate pain, reduce nerve compression, and improve function.

Post-Surgical Care

Physical therapy usually begins shortly after surgery to aid in recovery with a focus on gentle stretching, strengthening exercises, and gradually increasing activity levels.

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