Extruded Disc Herniation Diagnosis and Treatments
What are the Diagnosis and Treatment Options for an Extruded Disc Herniation?
Some patients suffering from an extruded disc herniation do well with rest and conservative treatment options. When symptoms are severe and last more than 3 months with no relief from conservative treatment, patients may benefit from further diagnostic injections, and least invasive or surgical procedures.
If you are suffering from an extruded disc herniation and have failed to get adequate care or need a second opinion, contact us at the International Spine Institute for a FREE MRI review and 2nd opinion. You don’t need to suffer daily in pain.
How is an Extruded Disc Diagnosed?
A comprehensive diagnostic workup is essential to properly diagnose an extruded disc herniation. The following workup provides an accurate and thorough diagnosis and treatment options.
- Medical History – Inventory of symptoms, previous treatments and medical care.
- Physical Examination – A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic Tests – Generally, plain X-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.
- Pain Mapping Injections – These injections can be used for therapeutic relief, but more importantly, can pinpoint the pain generator – i.e. extruded disc herniation and bone spurs tethering a spinal nerve of spinal cord.
Non-Operative Treatment
- Medications – anti-inflammatory medication, muscle relaxers and on rare occasions narcotic medications
- Alternating Heat/Cold Therapy – during the first 24-48 hours
- Physical Therapy Exercises – including stretching, massage, and strengthening
- Chiropractic Care – many patients find relief in seeing a chiropractor for re-aligning and improving motion in “locked” joints.
Interventional Spine Procedures
- Epidural Steroid Injections: are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected spinal level at which the pain originates from.
Least Invasive Procedures
LESS IS SO MUCH MORE
At the International Spine Institute, we practice a LEAST INVASIVE PHILOSOPHY, an evolving philosophy of treating painful spine patients with less invasive procedures before ever considering traditional and minimally invasive spine surgery. Our spine procedures are less invasive than minimally invasive surgery. Improved technologies and techniques are tailored for pinpointing pain generators in the spine and then approaching the spine with either regenerative medicine (Stem Cell Therapy) or endoscopic procedures that relieve the pain and reduce the collateral damage and tissue disruption that MIS and traditional spine surgery can cause.
If pain still persists after conservative treatment and interventional spine injections, and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended.
The following least invasive procedures can treat extruded disc with 90% success:
- Endoscopic Discectomy: With an incision less than a ½ inch, the surgeon can avoid most bone resection and enter the spinal canal without disturbing or cutting muscle. The surgeon directly observes the herniated disc in a water (arthroscopy) environment with a surgical working channel endoscope coupled with an HD camera. Recovery is superior to microdiscectomy, with most patients returning to work within a 1-2 weeks. Conscious sedation is used with the patient awake, comfortable and aware during the procedure.
ADVANTAGES OF LEAST INVASIVE PROCEDURES
- Faster recovery
- Faster return to work, school and play
- Less post-operative pain
- Reduced complications and scarring
- No General Anesthesia is needed
Minimally Invasive Spine Surgery
In some cases and extruded disc herniation may not be able to be treated with our least invasive techniques, and therefore we use one the minimally invasive techniques widely used by spine surgeons across the world.
- MIS Discectomy – A minimally invasive approach involves a small 15-20mm incision and sequential dilating tubes that gently spread the muscles to afford visualization to the spine. The goal of the technique is decompression of bone or disc that is pressing on the spinal nerves, without a fusion. With this technique, patients have better recovery than traditional open surgery that strips muscle from the bone in order for surgeons to see.
- MIS Transforaminal Lumbar Interbody Fusion (TLIF) – The specific advantages of the MIS TLIF are to minimize the risks and maximize the speed to recovery compared with traditional open spine surgery. With the MIS TLIF muscle damage and pain intensity are greatly reduced. This fusion provides stability for the spine by stopping movement that used to cause mechanical pain when the patient moved. The surgery also provides complete decompression of any pressure on the nerves at this level.
Recovery
Least Invasive Procedures
Most patients can begin getting out of bed one hour after surgery and go home shortly afterwards. Activity is gradually increased and patients are typically able to return to work within a 1-2 weeks. There will probably be some pain after the procedure and is usually localized to the incision site. However, just because there is less or no pain, always consult your physician or orthopedic surgeon before beginning any physical work.
Minimally Invasive Spine
Generally, patients are kept overnight for observation and pain control with Intravenous medications. However, one could go home the same day if there are recovered from anesthesia and their pain is well controlled with oral medications. Dr. Rodriguez usually has patients wear a supportive brace when out of bed for 6 weeks. This should diminish the pain and decrease the risk of re-herniating the disc. Physical therapy is typically suggested and may be required after 6 weeks. Most patients return to work 6 weeks after the procedure. Patients doing heavy lifting jobs may need to wait 3-6 months (after adequately rehabilitating the muscles) before they can return to full duty.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a week after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.
