Discs are the relatively soft, gelatinous cushions that surround the spinal cord and act as shock absorbers between the hard, bony vertebrae. A herniated disc is a protrusion of the disk material, usually through small openings in the vertebrae where nerves enter the spinal column.

Disks herniate most commonly in the lower back, although they also occur frequently in the lower neck and more uncommonly may occur anywhere.

Depending on where the herniation occurs, and the degree to which nerves entering the spine, or the spine itself, are affected, a wide range of symptoms are possible. In addition to pain around the site of the herniation, many disk patients also experience significant pain somewhere other than where the disk is. This is because when disks ooze and bulge, they ooze and bulge into spaces occupied by nerves. Because these nerves are carrying impulses from different parts of he body to the spine and then to the brain, the pain is experienced as if it were occurring in the area from where the nerve originates.

With lower back herniations caused by trauma, patients typically experience sudden and severe pain which usually recedes without treatment and then gradually worsens over time. Often , if the sciatic nerve, which carries impulses from the legs to the spine, is involved there is dull, burning pain in the back of the leg, sometimes extending all the way to the foot. Sitting, bending, sneezing, coughing - almost anything that can cause the disk to exert pressure on the nerve, will cause pain.

In herniations of disks in the neck , the side of the neck, pain may appear in the shoulder, neck, outer part of he upper arm, or the inside of the forearm.

Physical examination can often reveal not only the fact of a herniation but even its site. For example, a herniation between the fourth and fifth lumbar vertebrae will manifest itself by a patient having difficulty bending the big toe and in attempting to walk on the heels. (Of course, everybody, except perhaps circus acrobats, has trouble walking on his heels, but, not to worry, years of training and experience have uniquely qualified your doctor, to distinguish between a natural healthy clumsiness and the signs of a diseased disk.)

Similarly, herniations in the neck often reveal sensory deficits and weaknesses in the muscles of the arms, the thumb and some of the fingers, depending o the location of the affected disk. Several kinds of imaging tests, including x-rays, CT scans, MRI's and other more exotic imaging tests can confirm and elucidate the findings of a physical exam. In general, bulging disks are rarely a diagnostic mystery.

Large extruded fragment at L4-L5 encroaching on traversing nerve.

Treatment is a different story. To be honest, doctors often disagree about the treatment of disk disease. The fact is, there are many different kinds of treatments available;and just as different doctors often approach the same problem in different ways, different patients sometimes respond to the same treatment in very different ways.

Most doctors do agree, at least, that initially, conservative treatment is best, unless there is clear evidence of severe nerve involvement, significant loss of sensation, partial paralysis, or bowel or bladder dysfunction. By conservative therapy, we mean such things as bedrest, mild stretching exercises, heat or ice, massage, braces or corsets, and drugs to reduce pain, relax muscles and reduce inflammation. Cervical (neck) or pelvic (lower back) traction, ultrasound therapy and electronic nerve stimulation are also options.

For disks that do not respond to conservative treatment, there is a surgical option. Actually, the truth is there is more than one surgical option, and this is where most of the controversy in the treatment of disk disease originates.

Basically, surgery can not repair the disk itself. What it can do is provide more room for the herniated disk to bulge in, thereby reducing pressure on the nerves and therefore pain.

The older, more radical version of this surgery is called a laminectomy. The lamina, or back of the spinal canal is entirely removed.

In the newer version of this procedure, called a laminotomy, only the small part of the lamina directly surrounding the affected disk is removed.

Although some doctors still prefer the older more radical surgery, there is growing evidence that the newer, less invasive procedure, the laminotomy is superior. The reason is simple: the less bone that is removed, the more strong and stabile the remaining structure is. While removing more lamina will often relieve symptoms initially, there is far greater rate of subsequent complications, often worse than the original problem, because of the resulting spinal instability.

In virtually all cases, we strongly recommend laminotomy over laminectomy.