Herniated Disk in the Lower Back

Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain (sciatica).

Between 60% and 80% of people will experience low back pain at some point in their lives. A high percentage of people will have low back and leg pain caused by a herniated disk.

Although a herniated disk can sometimes be very painful, most people feel much better with just a few weeks or months of nonsurgical treatment.

Anatomy

Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.

Five vertebrae make up the lower back. This area is called your lumbar spine.

Parts of the lumbar spine.

Other parts of your spine include:

Spinal cord and nerves. These “electrical cables” travel through the spinal canal carrying messages between your brain and muscles.

Intervertebral disks. In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when your walk or run.

Intervertebral disks are flat and round, and about a half inch thick. They are made up of two components:

Healthy intervertebral disk (cross-section view).

• Annulus fibrosus. This is the tough, flexible outer ring of the disk.
• Nucleus pulposus. This is the soft, jelly-like center of the disk

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Minimally Invasive Spine Surgery

Minimally Invasive Surgery:

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Recent surgical advancements have focused on performing surgery through smaller incisions, with less disruption to surrounding soft-tissues. The idea behind minimally invasive surgery is to perform the same treatment without damage to normal surrounding tissues. The drawback of minimally invasive surgery is that sometimes the underlying problem may not be adequately addressed because of an inability to get to the problem. Whenever a new minimally invasive procedure is introduced, there is almost always controversy as to whether or not the procedure is as good as traditional surgery.

Endoscopic Spine Surgery:

Endoscopic spine surgery uses specialized video equipment inserted through small incisions to see the structures of the spine. Similar to arthroscopic surgery of a joint, endoscopic surgery has advanced over the past decade from merely being able to look to the area of interest, to the ability to repair and reconstruct a variety of complex problems.The benefit of endoscopic spine surgery is the potential to address problems through very small incisions. By not damaging the muscles around the spine, recovery can often be much faster than with a larger surgical exposure.

Microdiscectomy, Microlaminectomy and Microforamenotomy:

All of these micro-surgeries are variations of standard surgeries used to take pressure off of the nerves around the spinal cord. Traditionally done through larger incisions, the micro procedures use smaller incisions and specialized surgical instruments to accomplish the same goals of traditional surgery.There is no rule on where the line between traditional surgery and micro surgery is drawn. To some doctors this means a smaller incision, to others it means the use of special surgical instruments. Many variations of a procedure could be considered micro surgery.

Laser Spine Surgery:

Laser spine surgery is a technique that uses a laser to remove damaged tissues. Because a laser can be inserted through small incisions, it can be used to cut away damaged tissues (such as disc fragments) without having to make a large incision.There is significant controversy about laser spine surgery as this technique has not been shown to have significant benefits, despite advertising that may make you think otherwise. Often marketed in magazines and the Internet, laser spine surgery has become the focus of some lawsuits formisleading patients about expected results from surgery.

Is It Better?:

Is minimally invasive surgery better? There are many ways to answer this question. The bottom line is that we simply do not know. There are theoretic advantages, and there are possible downsides. But there are very few studies that compare the possible risks with the potential benefits of minimally invasive surgery.The bottom line I suggest is to find a surgeon who, above all, is interested in fixing your problem, not someone who is selling you on a smaller incision. If the same benefit can be achieved without damage to normal tissues, then minimally invasive surgery may be a good option.

_Sources:

_{Mathews HH and Long BH “Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation” J. Am. Acad. Orthop. Surg., March/April 2002; 10: 80 – 85.}

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Regenerative Medicine

Administering undifferentiated stem cells to an injured disc has made adult stem cell regenerative medicine in spine a reality. Adult stem cell regenerative medicine holds the promise of stabilizing or even reversing the degenerative changes associated with aging or following traumatic injury. Current clinical use of stem cells is very limited, in part by the cumbersome approval process. The use of concentrated bone marrow aspirate (BMC) as a “stem cell” preparation is currently the simplest and safest way of utilizing the regenerative potential for mesenchymal stem cells (MSCs) to promote tissue regeneration. In fact, stem cells concentrated from bone marrow have been shown to stimulate the formation of bone, cartilage, ligament and tendon, and dermal tissues.

Conservative treatment options for lumbar and cervical pain associated with discogenic disc disease (Pfirrmann Grades 3-6) are limited. Treatment options include pain medication, steroids, physical therapy, and chiropractic care. Reversal of disc pathology has not been achieved with current available treatment modalities. Failure of these nonoperative treatments may leave surgical intervention as a treatment option.

The goal of utilizing MSCs is to not only potentially provide pain relief from the painful degenerative disc, but to reverse the degenerative process. There are three methods for placing MSCs into the painful nucleus pulposus.

The use of allogeneic mesenchymal precursor cells (MPCs) is currently being evaluated as a part of an FDA Phase I clinical trial. Extracted from donors and expanded in number by tissue culture, this process isolates and grows the stem cells into pure MPCs which are injected into the nucleus pulposus. This technology does not have FDA approval.

Utilizing expanded, autologous MSCs for injection into the painful disc is the second method. Federal regulations require the approval of an Investigational New Drug application supported by prospective, randomized clinical trials for the use of expanded autologous MSCs. The FDA has not approved this technology.

The third method involves autologous point of care therapy. This technology does not require FDA approval. The patient’s own MSCs are directly injected into the nucleus pulposus of the symptomatic degenerated disc(s) using standardized two needle discography technique. This requires fluoroscopic visualization and 2-3cc of MSCs are slowly injected into the symptomatic nucleus pulposus.

Early analysis of the research data reveals the average lumbar pre-treatment Oswestry Disability Index (ODI) was 56.5% and improved to 22.4% at three-month follow-up (P=0.0001). The average lumbar pre-treatment Visual Analogue Scale (VAS) for pain was 7.9 (on a scale of 1-10) and improved to 4.2 at three months (P=0.0005).

There have been no complications associated with the iliac crest aspiration or disc injection. Thus far no patient in the study has undergone spine surgery following treatment. Results obtained with this technique suggest its potential clinical efficacy in the treatment of moderate to severe degenerative disc disease. These results require verification with longer follow-up and randomized prospective studies.

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Laser spine surgery is a minimally invasive surgery highly acclaimed by surgeons across the nation

Laser Spine Surgery/Endoscopic Spine Surgery

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Laser spine surgery is a minimally invasive surgery highly acclaimed by surgeons across the nation. It was introduced over 30 years ago, and has recently been excessively rising in popularity with evolved technology and knowledge. Laser spine surgery is typically a go-to procedure for patients with neck and back pain. Using lasers, doctors and neurosurgeons can more precisely target soft tissue to help relieve pain and ridding of excess dead tissue surrounding the spine. It is also a procedure used to trim any bulging or herniated discs to ease pressure on the spinal column and nerves.

Laser spine surgery has historically has been done by “going under the knife”, but with laser spine surgery, patients can rest assured that this minimally invasive procedure requires concentrated beams of light to relieve back pain. With laser spine surgery, the effects are safer and much more controlled. The result of the surgery is less blood loss, which results in a faster healing process, and minimal scarring due to it being less invasive. Also, using lasers can greatly decrease the amount of damage to any muscles or spine surrounding tissues because of the increased ability to control the concentrated beam of light, rather than “hand and knife.”

Although laser spine surgery is said to have unproven benefits by the National Institute of Health, doctors everywhere have relied on its usefulness to help relieve back and neck pain in countless patients. Laser spine surgery has become wildly popular in the medical field, and it is continuously and rapidly growing into an effective, helpful, and patient-convenient procedure that will undoubtedly continue to climb the charts.

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Lumbar and Cervical Radiofrequency Ablation and Lesioning

What is Radiofrequency? 

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Radiofrequency waves are electromagnetic waves which travel at the speed of light, or 186,000 miles per second (300,000 km/s). Radiofrequency Energy is a type of heat energy that is created by a special generator at very high or super high frequencies. With the use of this specialized generator, heat energy is created and delivered with precision to target nerves that carry pain impulses. The resulting “lesion”involves a spherical area of tissue destruction at the tip of the RF needle that can include pain-carrying nerves.

Why is this procedure done?

Radiofrequency ablation/lesioning is a procedure used to provide longer term pain relief than that provided by simple injections or nerve blocks. Many patients who are being considered for this procedure have already undergone simple injection techniques like Epidural Steroid Injection, Facet Joint Injection, Sympathetic Nerve Blocks, or other nerve blocks with pain relief that is less prolonged than desired. By selectively destroying nerves that carry pain impulses, the painful structure can be effectively denervated and the pain reduced or eliminated for anywhere from a few months to up to 12 months.

How is this procedure done?

Once a structure has been determined to be a pain generator, its nerve supply is targeted for interruption. A small insulated needle or RF cannula is positioned next to these nerves with fluoroscopic guidance (live video X-Ray). Your doctor knows where to place the RF cannula because he is an expert in anatomy. The shaft of this cannula except for the last 5 to 10 mm is covered with a protective insulation so that the electric current only passes into the surrounding tissues from the very tip of the cannula. When the cannula appears to be in good position, the doctor may perform a test and release a small amount of electric current through the needle tip at two different frequencies. This test helps to confirm that the cannula tip is in close proximity to the target nerve and that it is not near any other nerve. After a successful test confirms good cannula tip position, a local anesthetic is injected to numb the area. The RF generator is then used to heat the cannula tip for up to 90 seconds, and thus the target nerve is destroyed.

What types of conditions will respond to Radiofrequency Lesioning?

There are a multitude of chronic pain conditions that respond well to this treatment. Chronic spinal pain, including spinal arthritis (spondylosis), post-traumatic pain (whiplash), pain after spine surgery, and other spinal pain conditions are those most commonly treated with RFL. Other conditions that are known to respond well to RFL include some neuropathic pain conditions like Complex Regional Pain Syndrome (CRPS or RSD), peripheral nerve entrapment syndromes, and other assorted chronic pain conditions. A patient’s candidacy for RFL is usually determined by the performance of a Diagnostic Nerve Block. This procedure will help to confirm whether a patient’s pain improves just for the duration of the local anesthetic (or not). Patients who have little to no pain relief after a diagnostic nerve block are not candidates for a neurodestructive procedure like RF Lesioning.

Does the procedure hurt?

This procedure is no more painful than any other injection procedure that is performed in interventional pain management. Patients are often given mild intravenous sedation during the procedure, but sedation is not absolutely required. Deep sedation is not a safe alternative and is therefore not offered for my RF procedures. It is quite common for neck or back pain to increase for a few days or longer after the RFL procedure before it starts to improve.

What should I do to prepare for my procedure?

On the day of your injection, you should not have anything to eat or drink for at least eight (8) hours before your scheduled procedure. If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure.

If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox. 

What should I do after my procedure?

Following discharge home, you should plan on simple rest and relaxation. If you have pain at the needle puncture sites, application of an ice pack to this area should be helpful. If you receive intravenous sedation, you should not drive a car until the next day. Patients are generally advised to go home and not return to work after this type of procedure. Some patients do return to work the next day.

Could there be side effects or complications?

BecomePainFree Doctors will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed.

Can this procedure be repeated if my pain returns?

It is possible for the treated nerve(s) to regenerate, which could lead to recurrent pain. However, RF Lesioning is repeatable for nerve regeneration if it worked the first time around.

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Mayo Clinic, Spine Surgeon, Mayo Clinic Back Surgeon, Mayo Clinic Pain, Mayo Clinic Fellowship Trained Surgeon, Mayo Clinic Doctor, Mayo Clinic Back pain

We have two spine surgeons in our group and one on the way from the world famous Mayo Clinic. These Mayo Clinic surgeons are some of the best in the United States of America both of these Mayo Clinic trained doctors work in Texas. Dallas, Fort Worth, San Antonio we ave you covered with Mayo Clinic trained spine surgeons. Here is the information on these doctors below.Check out our website at https://www.becomepainfree.com/

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Steven J. Cyr, M.D., FAAOS

Mayo Clinic Trained Spine Physician

Steven J. Cyr, M.D., FAAOS 

Steven J. Cyr, M.D., is a Board Certified Orthopaedic Surgeon who received extensive training to specialize in the delicate science of Spine Surgery. Anyone who knows Dr. Cyr well will tell you that he is a man driven for quality and excellence. His high standards can be seen throughout his educational process and career.
He received top honors at Southwest Texas State University by graduating Summa Cum Laude and Valedictorian with a Bachelor of Science in Biology. In addition to rigorous academics, he was also a member of the Bobcat football team during his three years at SWTSU.

Dr. Cyr gained early acceptance into medical school and earned his MD from the University of Texas Health Science Center in San Antonio. He then began his service to the United States Air Force with a transitional internship at Wilford Hall Medical Center. He served the air force community as a flight surgeon for two years before beginning residency training in orthopaedic surgery at Wilford Hall.

Following residency, Dr. Cyr was honored to be chosen from among the country’s top residents as the only fellow for the highly competitive and prestigious spine fellowship at the Mayo Clinic in Minnesota. This training program has ranked number one for orthopaedic and neurosurgical training programs in America for the last 20 years. Mayo combines these two fields, giving their surgeons an understanding of nerve and spine function unparalleled in most other programs.

Upon completion of his fellowship, Dr. Cyr and his family moved back to San Antonio, where he served the military population as the Chief of Air Force Spine Surgery and Spine Surgery Consultant to the Surgeon General of the Air Force. For six years, Dr. Cyr taught future air force orthopaedic surgeons in residency at Wilford Hall and has twice served our war wounded in Iraq at the Air Force Theater Hospital in Balad.

He has brought innovative techniques to the military and was the first to perform the total disc replacement procedure as well as endoscopic spinal surgery. He specializes in complicated spine issues and has gained notoriety for successful repairs of failed surgeries on patients from numerous other states and around the world. Dr. Cyr’s expertise and skills are now available to civilian patients at the Orthopaedic and Spine Institute, where his passion for excellence and quality keep him at the leading edge of spine surgery.

Mayo Clinic Trained Spine Physician

Dr. Venkat Sethuraman M.D. 

Mayo Fellowship Trained Board-Certified Spine Surgeon
Minimally Invasive Spine Specialist

Education Undergraduate: Rutgers College, New Brunswick, NJ

Medical: Medical College of Pennsylvania, Philadelphia, PA Training Orthopaedic Surgery

Residency: Thomas Jefferson University Hospital, Philadelphia, PA Spine

Fellowship: Mayo Clinic, Rochester, MN

Hospital Affiliations Baylor Irving Medical Center Irving Coppell Surgical Center Irving

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Offices:

Coppell :

2021 N. MacArthur Blvd 400 West IH 635 Bldg. @, Suite 115

Irving:

Plaza 1, Suite 200
Irving, TX 75061
Irving, TX 75063

Plano:

2301 Marsh Lane,
Plano, TX 75093

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Certificates/Diploma’s:

Listing Details

Address

2021 N. MacArthur Blvd, Irving, Tx, 75061

Tags

Mayo Clinic

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Texas Back Institute, Texas Back Institute Trained Surgeon, Texas Back Institute Fellow, TBI, Texas Back Institute Spine Surgeon

Dr Saqib Siddiqui M.D.

BOARD ELIGIBLE ORTHOPEDIC and SPINE SURGEON Trained by the Texas Back Institute in Plano, Texas

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Dr Siddiqui is proficient in treating cervical, thoracic and lumbar spinal conditions and disorders whether they require surgical treatment or non-operative treatment. Degenerative disc disease is a common problem that afflicts many individuals. There are many state of the art procedures available today such as artificial disc replacement (or spinal arthroplasty), dynamic stabilization, interspinous distraction for spinal stenosis, as well as more traditional options such as spinal fusion, epidural spinal injections, rhizotomy, spinal cord stimulators, selective nerve root blocks, facet blocks and sacroliiac joint injections. Dr Siddiqui is able to treat most of his patients conservatively with physical therapy, braces, injections and pain medications. If you do require surgical treatment ,you will have access to the world’s most advanced techniques such as minimally invasive spine surgery. Dr Siddiqui was the first surgeon in Houston to perform the XLIF (extreme lateral interbody fusion) which is a technique enabling the surgeon to fuse the lumbar spine through a 2 inch incision from the side, often being done as an ambulatory procedure at a surgery center. Dr Siddiqui is also one of only a handful of surgeons in Houston performing trans-sacral L5/S1 fusion also through a 1 to 2 inch incision. Dr Siddiqui also performs percutaneous discectomy for patients with a herniated lumbar or cervical disc. Patients are able to leave the surgery center in only a couple of hours after a 30 minute procedure sporting just a bandaid and little of no recovery time.

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Specialties

• Orthopaedic Surgeon
• Pain Management

Certifications

• Fellowship Trained

Area of Focus

• Degenerative Spine
• Spinal Deformity
• Tumor / Infection

Associations

• American Academy of Orthopaedic Surgeons
• American College of Spine Surgery
• North American Spine Society

Hospital Affiliations

• University General Hospital, Houston, TX
• Memorial Herman Hospital, Woodlands, TX
• Houston Northwest Medical Center
• Cyfair Fairbanks Medical Center
• Victory Medical Center Houston
• Victory Medical Center San Antonio
• Innova Hospital San Antonio

Languages spoken at this practice

• Spanish

Areas of Expertise

Conditions

• Abdominal Pain
• Acute Pain
• Auto/Work Related Injuries
• Back Pain
• Bursitis
• Cancer Vertebral Pain
• Carpal Tunnel Syndrome
• Cervical Spine Disorders
• Chest Wall Pain
• Chronic Pain
• Coccydynia
• Complex Regional Pain Syndrome
• Complex Spine Disorders
• Degenerative Conditions
• Extremity Dysfunction / Pain
• Facet Joint Pain
• Facet Syndrome
• Failed Back Surgery Syndrome
• Foot Drop
• Foot Pain
• Fracture
• Groin Pain

• Herniated/Bulging Disc
• Hip Pain
• Infections
• Joint Pain/Injury
• Knee Pain
• Kyphosis
• Leg Pain
• Ligament strain
• Low Back Pain
• Lower Back Pain
• Lumbar Spine Disorders
• Meniscal tears
• Migraine headaches
• Muscle Strain/Pain
• Musculoskeletal Disorders
• Myalgias
• Myelopathy
• Myositis
• Neck Pain
• Nerve Conditions
• Neuropathic Pain
• Osteoarthritis

• Osteoperosis
• Osteoporotic Compression Fractures
• Pain After Shingles
• Piriformis Syndrome
• Post Surgery Functional Problems
• Post Surgery Pain
• Radicular Pain
• Reflex Sympathetic Dystrophy (RSD)
• Rotator cuff injury
• Sacroiliac joint dysfunction
• Sciatica
• Scoliosis
• Shoulder Pain
• Spinal Deformity
• Spinal Stenosis
• Spinal Trauma
• Spondylolisthesis
• Spondylosis
• Tumors
• Work Injuries

Treatments

• ALIF (anterior lumbar interbody fusion)
• Anterior Cervical Discectomy / Decompression
• Arthroscopic Knee Surgery
• Artificial Disc Replacement
• Axial Lumbar Interbody Fusion (AxiaLIF®)
• Back Surgery
• CT Analysis
• CT Scan
• Cervical Spine Fusion Instrumentation
• Cervical Spine Surgery
• Decompression
• Disc Arthroplasty
• Discectomy
• Discography
• Dynamic lumbar stabilization
• Endoscopic Microdiscectomy
• Injections
• Joint Injections
• Knee Injections
• Kyphoplasty
• Laminectomy/Decompression Surgery

• Laminoplasty
• Lower Back Surgery
• Lumbar Corpectomy
• Lumbar Spine Fusion Instrumentation
• MRI Analysis
• Microdiscectomy / Microdecompression
• Minimally Invasive Interbody Fusion
• Minimally Invasive Spine Surgery
• Myelography
• Myelography Analysis
• Neck Surgery
• Nonsurgical Treatment and Diagnosis
• Nucleoplasty
• PLIF (posterior lumbar interbody fusion)
• Pediatric Spine Treatments-Surgical
• Percutaneous Spinal Fusion
• Physical Medicine & Rehabiliation
• Posterior Cervical Decompression
• Posterior Cervical Discectomy
• Posterior Cervical Foraminotomy
• Posterolateral Lumbar Fusion

• Reconstructive/Revision Spine Surgery
• Revision Total Joints
• Sacroiliac joint fusion
• Scoliosis Sugery
• Shoulder Injections
• Shoulder Surgery
• Spinal Decompression
• Spinal Fusion
• Spinal Injections
• Spinal Reconstruction
• Spinal Rehabilitation
• TLIF (transforaminal lumbar interbody fusion)
• Total Hip Replacement
• Total Knee Replacement
• Total Shoulder Replacement
• Upper Back Surgery
• Vertebroplasty
• X-ray Analysis
• XLIF (lateral lumbar interbody fusion)

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Back Surgery, Scoliosis, Adolescent Idiopathic Scoliosis, (AIS), congenital, idiopathic and neuromuscula

Cobb angle measurement of a scoliosis; concave side on the left; convex side on the right (Photo credit: Wikipedia)

Scoliosis problems are divided into three types of categories: congenital, idiopathic and neuromuscular.

• Congenital scoliosis indicates the patient was born with the curvature of the spine and is caused by a failure of the vertebrae to individually form or separate from each other.
• Neuromuscular type of scoliosis is caused by a wide variety of disorders which include cerebral palsy, Duchenne muscular dystrophy and myelomeningocele (also known as spina bifida). Each of these categories is very different and requires many different treatment interventions than adolescent idiopathic scoliosis.
• Idiopathic means the identifying cause of the disease/disorder is which is unknown

• Idiopathic scoliosis is divided into three ranging age categories based upon the initial presentation of the curve area:

• Infantile idiopathic scoliosis presents between the ages of birth and two/2 years old.
• Juvenile idiopathic scoliosis presents between the ages of three/3 and 10 years old.
• Adolescent idiopathic scoliosis presents between the ages of 11 and 17 years of age.

Come see one of our Scoliosis surgeons today at http://www.becomepainfree.com

Spine Pain, Back Pain. Spine Surgery, Back Surgery, Pain, Herniated Disc

Stages of Spinal Disc Herniation (Photo credit: Wikipedia)

A disc herniation is a common cause of neck and low back pain.  Terms to describe these disc problems include bulging, ruptured, slipped, or extruded areas.  Sometimes a disc herniation occurs spontaneously or incidental to injury, repetitive movements, or degenerative disc disease.

The intervertebral discs serve as your spine’s many shock absorbers.  Each disc is composed of a sturdy tire-like annulus fibrosis that encases a gel-like interior called the nucleus pulposus area.  Endplates anchor each disc in place between any two vertebral bodies.

Growing older can cause these issues; trauma, injury, smoking, poor diet, being overweight, and wear and tear can alter disc strength, resiliency and structural integrity.

Now what happens?

The annulus fibrosis—the protective band of the tissue protecting the nucleus pulposus—cracks, tears, or breaks wide open.  This allows some of the gel-like nuclear material to ooze outside the disc space.  A bulging disc—the nucleus pulposus remains contained within the disc—may be a precursor to herniation.  Escaping disc matter may cause:

• Nerve root compression
• Spinal canal compression
• Both

Symptoms

Your pain is the foremost symptom of a herniated disc.  The disc material, and potential loss of disc height, compresses the spinal nerves, cord and/or canal.  Furthermore, within the escaping disc matter is a chemical irritant that causes nerve inflammation and pain.  Neck, spine or back pain may spread into your arms or legs and shoot down pain.  Cervical radiculopathy and sciatica (lumbar) are examples.

Cervical Disc Herniation	Lumbar Disc Herniation
Neck pain, mild to intense	Low back pain, mild to intense
Upper extremity pain, weakness	Buttock, leg pain and/or weakness
Hand clumsiness	Difficult and painful to walk, stand, bend forward, backwards, side-to-side
Movement increases pain	Movement increases pain
Neck, Shoulders, Arms, Hands	Low Back, Buttocks, Legs
Sensations: burning, tingling, numbness, pins and needles	Sensations: burning, tingling, numbness, pins and needles
Rare, bladder and bowel dysfunction	Rare, bladder and bowel dysfunction

English: CT scan image of lumbar disc herniation (Photo credit: Wikipedia)

The accurate diagnosis

Consult an expert, especially if neck or back pain develops suddenly, quickly worsens, or you have a pre-existing spinal disorder.  An accurate diagnosis is essential to an effective and successful treatment plan.

Your medical history and physical and neurological examinations are very important the all surgeons and pain doctors.  You and your doctor discuss your symptoms, when they developed, and treatments tried etc.  The doctor tests your reflexes and evaluates you for muscle weakness, loss of feeling, and signs of neurological injury.

Diagnostic tests may help the doctor confirm which disc (or discs) is damaged.  A simple spinal x-ray or C.T. can show collapsed disc space.  CT and MRI are sensitive imaging tools that detail bone, disc and nerve structures.

Many treatment options

Non-surgical treatment often helps to relieve any pain and symptoms.  Your doctor may combine two or more therapies to maximize the success of your treatment.

Non-surgical treatments

• Activity modification
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Pain medication (a narcotic, painkiller)
• Muscle relaxing medication
• Spinal injection
• Short-term bracing supports the spine, may help relieve pain
• Physical therapy
• Acupuncture

When your surgeon may discuss surgical treatment

• Spinal instability
• Neurologic dysfunction
• Pain and symptoms are unrelenting
• Non-operative treatment fails and pain persists

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