When your back hurts, everyday activities can become difficult or even unbearable. Sitting, bending or twisting can cause sharp pain, a dull ache, or annoying tingling and numbness. One cause of back pain is a herniated disk, sometimes called a slipped disk or a ruptured disk.  A herniated disk is most often the result of a gradual, aging-related degeneration.  As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist. Using your back muscles instead of your leg and thigh muscles to lift large  heavy objects can lead to a herniated disk, as can twisting and turning while lifting.  More rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.

You can also have a herniated disk without knowing it — herniated or bulging disks sometimes show up on x-ray images of asymptomatic patients. But some herniated disks can be painful. The most common symptoms of a herniated disk are:

•    Sciatica — a radiating, aching pain, sometimes with tingling and numbness, that starts in the buttock and extends down the back of one leg

•    Pain, numbness or weakness in the lower back and one leg, or in the neck, shoulder, chest or arm

•    Low back pain that worsens when you sit, cough or sneeze

The Pain Management Center at Eastern Long Island Hospital is now performing endoscopic diskectomy, a minimally invasive surgical procedure to remove herniated disk material. Using local anesthesia with the help of fluoroscopy and magnified video for guidance, a small specially designed endoscopic probe is inserted through the skin of the back, between the vertebrae and into the herniated disk. Tiny surgical instruments are sent down the hollow center of the probe to remove a portion of the painful disk. The microsurgical instruments can also be used to push the bulging disk back into place and for the removal of disk fragments and small bone spurs.

The procedure takes about an hour.  Normally there is little, if any, pain or discomfort. Upon completion, the probe is removed and a small band-aid is placed over the incision. The amount of disk material removed varies, but the supporting structure of the disk is not affected by the surgery. The access route to the disk consists of only the probe's small puncture site, usually the size of a freckle. This is much smaller than the large incision required for open back surgery.

Endoscopic diskectomy is different from open lumbar disk surgery in that there is no back muscle dissection, no bone removal, or large skin incision. The risk of complications are drastically reduced or eliminated with this procedure.

Making the diagnosis of a herniated disk, and coming up with a treatment plan depends on the symptoms experienced by the patient, the physical examination as well as the x-ray and MRI findings.  

Conservative treatment: avoiding painful postures, adhering to a course of physical therapy and a pain-medication regimen usually relieves symptoms in nine out of 10 patients with disk herniations. After a few months of conservative treatment, you should be back to normal activities. Imaging studies show that the protruding or displaced portion of the disk diminishes with time, corresponding to symptomatic improvement.

Depending on your symptoms, your doctor may recommend:

o    Modified activity. Take it easy when you have severe back pain. Try to stay away from activities that aggravate your symptoms, such as improper reaching, bending and lifting, using certain exercise equipment and prolonged sitting.

However, remember that the spine and disks rely on motion for their nutrition. Intermittent activity to maintain fitness and minimize stiffness is very important, so physical therapy and exercises to increase flexibility and strength may be prescribed.

o    Physical therapy. A physical therapist can apply heat, ice, traction, ultrasound and electrical stimulation for pain relief. Physical therapists can also show you positions and exercises designed to minimize the pain of a herniated disk. As the pain improves, physical therapy can advance you to a rehabilitation program of core strength and stability to maximize your back health and help protect against future injury.

o    Heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you may switch to gentle heat to give relief and comfort.

o    Pain medication. If your pain is mild to moderate, your doctor may tell you to take an analgesic medication, such as aspirin, ibuprofen, acetaminophen or naproxen. Muscle relaxants may be prescribed for a few days if you have back or limb spasms.

o    Bed rest. Constant, severe back pain from a herniated disk sometimes requires one or two days in bed on a firm surface or mattress. Strict bed rest for longer than a day or two, however, can inhibit recovery by causing loss of muscle tone.

o    Surgery.  About 10 percent of people with herniated disks eventually need surgery. You may be a good candidate for surgery if conservative treatment fails to improve your symptoms after four to six weeks. Surgery also may be considered if a disk fragment is pressing on a nerve, or if you're having trouble standing or walking.

o    Time. Herniated disk symptoms generally take four to six weeks to significantly improve. If your symptoms have not resolved after six weeks, more aggressive therapies may be effective and prevent you from needing surgery. These may include epidural injections or endoscopic diskectomy.
This information is provided by Frank J. Adipietro, M.D., a board certified anesthesiologist and pain management specialist at Eastern Long Island Hospital.

This information is provided by Frank J. Adipietro, M.D., a board certified anesthesiologist and pain management specialist at Eastern Long Island Hospital.