The spine has bony vertebrae and discs. Inside the spinal canal lies spinal cord. The disc acts as a cushion between the two vertebrae. The disc is comprised of soft gelatinous center and tough outer core. When this gelatinous material pushes out through a tear in the outer wall, the disc herniates. This herniated disc puts pressure on the surrounding nerves. The cause of herniated disc could be simple wear and tear as we age or with daily movements, trauma, sudden lifting of heavy weight. . As we age the water content in the disc decreases and it gets tough for it to support the body weight.
The symptoms of disc herniation are pain at the herniated disc sight along with radiation of shooting pain to one or both the legs. It could be associated with tingling and numbness in feet or legs. The pain gets worse with bending forward, twisting or sitting. Pain gets worse with coughing and sneezing. In severe cases, it may cause loss of bladder control, bowel control, loss of balance and loss of power in either of the extremity.
Diagnosis
Examination – Positive Straight leg raise, tenderness at the injury site, difficulty in bending forward.
MRI lumbar spine is best way to diagnose the severity and level of disc herniation.
Treatment
Lumbar belt – Only during traveling and prolonged walking, tuck in your abdominal muscles while wearing it. Avoid wearing it at all times.
Medications – anti-inflammatory, neuropathic medications can help decrease the inflammation,
Physical therapy – it includes heat therapy, local therapy to release the knots, ultrasonic therapy and certain exercises to strengthen the back muscles.
Selective nerve root block – If pain is not cured or getting worsened despite medications, then we do this procedure.
This is done under image guidance which is either c arm ( X ray machine) or the ultrasound. These injections targets the nerve as they come out of the spinal canal through a transforaminal route. The procedure is done under local anesthesia.
Patient is made to lie in prone position with a pillow under the abdomen. The skin is the cleaned with sterile solution and area draped with clean sheets. The skin with be numbed with some local anesthetic which may sting for few seconds. A small needle is then inserted through that area and taken close to the target nerve with the help of X ray guidance. A contrast dye is then injected to check the exact position of the needle tip. Then the medication is injected around the nerve. The needle is then taken out and band aid is applied at the side of injection.
Post procedure instruction.
- Ice pack at the injection site for first 2-3 days.
- Only light activities for first 2-3 days
- Start exercise from day 3-4 after the injection, which are safe in disc herniation cases or advised by your pain physician
Surgery – Laminectomy or discectomy is advised if there are symptoms like loss of bladder control, bowel control, loss of balance and loss of power in either of the extremity are present.
PREVENTION
Few tips to avoid and treat back pain are :
- Daily Exercise – in the form of aerobic exercise , light yoga, brisk walking and or swimming.
- Maintain healthy body weight – Higher the weight, more is the pressure on the spine, especially the lower lumbar spine.
- Correct Weight lifting technique – First bend you knees and keep the weight to be lifted as close to the body . Correct Posture While sitting, keep your back straight with shoulders pulled back and stomach tucked in. Your laptop should be at your eye level. Most of the weight should be on balls of your feet with feet being a width apart. It is also important to get up and walk every 30 min to 1 hour to get a good stretch.
- Stop Smoking – As nicotine present in the smoke decrease the blood supply, it has bad effect of bone health.
- Right Posture : – Sit with spine straight, shoulder little backward and abdomen tucked in. While prolonged sitting take a walk every 1-2 hours for a good stretch.
FOR MORE INFO AND DEMONSTRATION OF ACTUAL PROCEDURE OF SELECTIVE NERVE ROOT BLOCK, FOLLOW THE LINK https://youtu.be/Ry8G72P0h5g
