Wednesday, July 23, 2008

Herniated disc treatment

So you have been diagnosed with a herniated disc. What now? I always recommend that patients educate themselves and understand the anatomy and physiology (how things work) of the area. Spinal decompression specialist Dr. Steven Shoshany. Herniated disc treatment in NYC
There are several different classifications of disc herniations. I have them posted on my website
In layman's terms, a disc herniation occurs when the inside of the intervertebral disc (nucleus pulposus) tears its way through the posterior outer portion of the disc (annulus fibrosus) and invades the space where the delicate neural structures reside (i.e., the anterior epidural space). The presents of this nuclear material in the anterior epidural space may irritate these neural structures, which in turn may cause the patient to suffer severe back and/or leg pain. some of the more common classification of herniation.

The term 'Disc Herniation' (or 'disc prolapse' as they use in Europe) is a broad and general term that includes three specific types of disc lesions, which are classified based on the degree of disc disruption and posterior longitudinal ligament (PLL). The three main classifications of disc herniation are Protrusion (aka: contained herniation or sub-ligamentous herniation), Extrusion (aka: non-contained herniation, or trans-ligamentous herniation) and Sequestration (aka: free fragment). General Information and Confusion:

In 1934 the syndrome of "disc herniation" was born when Mixter and Barr first proclaimed that a posterior rupture of the intervertebral disc that allowed nuclear material to escape and compressed the adjacent spinal nerve root(s) was a common cause of back and leg pain - sciatica (125). For nearly 70 years this assertion has held true without much challenge(170).

However, modern research as demonstrated that the relationship between disc herniation and its often associated sciatica are a far more complex and bewildering phenomenon than once realized. For example, since the invent of MRI, we have learned that some patients have disc herniation on MRI, yet have no pain at. And, visa versa, some patients have terrible back and leg pain, yet have no disc herniation! Moreover, when post MRI is performed on some patients that once suffered disc herniation induced back and leg pain, the herniation is still there, yet the patient is gone. Conversely, some patients who fail to recover from back and leg pain, demonstrate a disappearance of the once prominent disc herniation.

Other ironies of disc herniation have been discovered as well. For example, we have learned from the work of Karppinen et al. that the size and severity of disc herniation do NOT correlate with the degree of patient pain, disability, or suffering (170). That is, small disc herniations and even disc bulges may causes just as much pain and disability as massive disc herniations and even extrusion.

Another strange irony is the fact that smaller, less complete, and innocent looking disc herniations (i.e., contained herniations, protrusions and/or disc bulges) are usually more difficult to treat and respond less favorably to decompressive surgery (discectomy) than do the larger and more advanced disc extrusions and sequestrations. (50) Moreover, symptomatic contained herniations have a poorer prognosis for recovery than do the larger more complete disc extrusions and sequestrations do. (50) And, to further cloud the water, we now know that sciatica (a horrible burning lower limb pain associated with disc herniation) is not always causes by the direct pressure from a herniated disc. That is, it can be caused from nuclear material "leaking" from the back of the disc onto the adjacent nerve roots, i.e., chemical radiculopathy(3,4) and/or from chemical and pressure irritation of the posterior intradiscal nerve fiber, i.e., the sinuvertebral nerves, which is called discogenic sciatica.
Spinal decompression has been proven to be a effective treatment for herniated discs.

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