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Disc Herniation Treatment
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What is Disc Herniation?
Disc herniation, commonly referred to as a herniated or ruptured disc, is a spinal condition that can lead to discomfort and pain. It involves the intervertebral discs, which are soft, cushion-like structures located between the vertebrae. These discs act as shock absorbers and allow for mobility in the spine.
In disc herniation, the inner, jelly-like material of a disc protrudes through its tougher outer layer, potentially pressing on nearby nerves which causes pain and other symptoms.
Causes of Disc Herniation
The primary cause of disc herniation is the wear and tear of intervertebral discs, often associated with ageing. These discs are needed to maintain spinal flexibility and absorb shocks.
- Age
As individuals age, spinal discs lose water content, becoming less flexible and more prone to damage. This degeneration may result in small tears or cracks in the disc’s outer layer, which could lead to herniation. - Trauma
Sudden, forceful movements or injuries, such as those from accidents, falls, or sports incidents, can directly lead to herniation. - Repetitive Strain
Repeatedly stressing the spine through activities like heavy lifting or bending may increase the risk of disc wear and tear. Poor lifting techniques and physically demanding occupations increase this risk. - Genetic Predisposition
Individuals with a genetic predisposition might have variations in the structure and composition of their spinal discs, potentially increasing their susceptibility to herniation. - Smoking
Smoking is linked to increased disc degeneration and a higher risk of herniation due to its adverse effects on the blood supply to spinal discs.
Symptoms and Signs
Symptoms of disc herniation vary based on its location and severity. They can include:
- Pain: This can range from a dull ache to sharp, shooting sensations. Pain may be localised to the back or neck, or radiate into the arms or legs.
- Numbness and Tingling: These sensations often occur in areas served by the affected nerve.
- Muscle Weakness: Muscle strength may be compromised, affecting movement and task performance.
- Altered Reflexes: Nerve compression may have an impact on reflexes.
- Bowel or Bladder Dysfunction: In rare cases, severe lower back herniation can lead to these symptoms, requiring immediate medical attention.
Diagnosis
The diagnosis of disc herniation involves several key steps:
- Medical History and Physical Examination: This combines a review of the patient’s medical background, focusing on symptom onset, previous injuries, and existing medical conditions, with a physical examination. The examination assesses neurological function, including muscle strength, reflexes, and sensation, providing initial insights into the patient’s condition.
- Imaging Studies: MRI and CT scans can offer detailed images of spinal structures, enabling precise identification of herniation location and extent.
- Electromyography and Nerve Conduction Studies: These are used to evaluate the functioning of nerves potentially affected by the herniated disc.
- Diagnostic Injections: Techniques like epidural steroid injections can confirm the source of pain.
- Discography: Involving the injection of contrast dye, this procedure helps identify specific discs responsible for the symptoms.
Non-Surgical Treatment Options
Non-surgical methods focus on alleviating pain and improving function in cases of herniated discs.
Rest and Activity Modification |
Initial management suggested by the spine specialist may include rest and reducing activities that aggravate the condition. Patients are educated on proper body mechanics and ergonomic principles to minimise spinal stress, which can help prevent further injury and aid recovery. |
Physical Therapy |
Tailored exercise programs focus on strengthening the muscles supporting the spine. These exercises also aim to improve spinal flexibility and posture, which can help alleviate pain and prevent recurrence. |
Medications |
A range of medications, including non-steroidal anti-inflammatory drugs for reducing inflammation, muscle relaxants to ease muscle spasms, and pain relievers for managing discomfort, can be prescribed. These address various aspects of the pain and inflammation associated with disc herniation. |
Heat and Cold Therapy |
Application of heat or cold packs to the affected area is a simple yet effective method for temporary relief. Heat therapy increases blood flow and relaxes muscles, while cold therapy reduces inflammation and numbs sore tissues. |
Epidural Steroid Injections |
For persistent pain, corticosteroid injections are administered into the epidural space near the affected nerve. This treatment aims to reduce nerve inflammation and pain, providing relief in many cases. |
Surgical Treatment Options
When non-surgical methods are ineffective or for more serious cases of disc herniation, surgery may be considered.
Microdiscectomy
This procedure targets the specific portion of the herniated disc that compresses the nerve. Minimally invasive techniques can be used to remove this fragment, which often results in rapid pain relief and recovery. It is particularly effective for patients with severe or debilitating pain that has not responded to conservative treatments.
Laminectomy
When herniation is accompanied by spinal stenosis (narrowing of the spinal canal), a laminectomy can be performed. This involves removing part of the vertebral bone (lamina) to create more space for the nerves, thereby relieving pressure and pain.
Spinal Fusion
This is considered in cases of severe instability in the spine caused by disc degeneration. By fusing two or more vertebrae, the spine is stabilised and pain can be alleviated. This reduces spinal flexibility and necessitates a longer recovery period.
Artificial Disc Replacement
As an alternative to fusion, this surgery involves replacing the damaged disc with a prosthetic one. This aims to maintain spinal motion, reduce pain, and prevent the degeneration of adjacent segments of the spine, a common complication after fusion surgery.
Prevention Strategies
Several preventive measures can help reduce the risk of disc herniation.
- Maintain a Healthy Weight - Maintain a healthy weight to help reduce excess stress that may otherwise be placed on the spine.
- Regular Exercise - Engage in activities that strengthen core muscles and improve spinal health. This may include low-impact exercises like swimming or walking.
- Safe Lifting Techniques to Prevent Strain - Proper lifting methods can help minimise back strain during physical activities, especially in occupations involving heavy lifting.
- Keeping a Proper Posture - Practicing good posture, both while sitting and standing, helps alleviate strain on the spine.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
What Is the Fastest Way to Heal a Herniated Disc?
Accelerating the healing process for a herniated disc involves an integrated approach, including rest, appropriate physical activities, and medications. Engaging in physical therapy that strengthens the back and improves flexibility is beneficial. A spine specialist can offer a personalised treatment plan suited to your specific condition.
How Long Does a Herniated Disc Take to Heal?
Recovery time varies, depending on the severity of the herniation and the chosen treatment approach. While some patients may notice improvement within weeks, others might require months. Consistent follow-up and adherence to the treatment plan can help facilitate recovery.
Is It Better to Rest or Move With a Herniated Disc?
Managing a herniated disc requires a balanced approach to rest and movement. While rest can initially alleviate acute pain, prolonged inactivity might worsen symptoms. Guided exercises and physical therapy can improve recovery outcomes.
What Happens If Disc Herniation Is Left Untreated?
Untreated disc herniation can lead to persistent pain and potential long-term complications. Early assessment and treatment by a spine specialist can help avoid these outcomes and improve quality of life.