Disc Syndromes and Sciatica
Disc
syndromes occur when a disc herniates (ruptures) allowing
material to leak out of the disk into the spinal canal.
Sometimes this material will "pinch" a nerve causing what is ofren referred to as sciatica.
The net result is pain radiating into the arm and/or
leg. For true disc syndromes extremity symptoms are
usually constant -- as opposed to intermittent -- and
usually travel to the hand (for a neck herniation)
or foot (low back herniation) whereas referred (non-pinched
nerve extremity symptoms) symptoms often stop at the
elbow or knee.
Studies show that only about
1 in 10 disc syndromes eventually need surgery so non-operative
care is often very successful (Disc Syndromes and Sciatica References
3 and 4). In fact, the American Academy of Orthopedic
Surgeons recommends delaying surgery for 3-6 months
unless one of the following conditions are met:
The
indications for immediate surgery are:
Cauda Equina
Syndrome: This is a massive herniation causing
altered bowel or bladder control and sometimes
paralysis. Although rare, this entity is a surgical
emergency.
Progressive Neurological
Deficit: This refers to a disc syndrome in
which neurological abnormalities such as weakness,
numbness, reflexes, etc., are documented to deteriorate
over time. A neurologic deficit which is present
but not deteriorating can be observed without surgery.
Neurologic deficits associated with disc herniations
are common but progressive deficits are uncommon.
Persistent Severe
Pain: This is another indication for surgery
but often medication, epidural shots and other
pain-control treatments can be used to control
symptoms so that conservative care can be tried.
The decision to
do surgery is based primarily on the physical exam,
not the MRI or CT scan. In fact, some of the worst
looking disc herniations on scans produce very little
and sometimes no symptoms at all (more
details on asymptomatic disc herniations). Furthermore, large disc herniations
often shrink and totally disappear on scans reflecting
the body's ability to heal.
Some
reasons to avoid surgery include:
Few patients want surgery but they also are concerned that if they refuse they might suffer permanent damage. Two large government funded studies have addressed this question providing more information to help patients make informed decisons.
PNBC has developed a conservative
treatment program for patients with disc syndromes
who do not need immediate surgery. It involves a
very controlled, supervised light exercise program
designed to specifically improve the healing physiology
in the affected disc area and prevent recurrences
through specific strengthening.
As symptoms improve,
exercise intensity is increased in order to normalize
any strength deficits in the back or neck. This is
very important because after spine injuries patients
are at risk for recurrence. Medical evidence suggests
that spinal deconditioning may be an important factor
in this increased risk. Finally, PNBC recommends
that post-surgical patients get their back strength
tested and, if weak, consider the program for these
very same reasons.
For more scientific
information on disc herniations click HERE.
