Getting Smart About Disc Problems

Do you or someone you know have a suspected "slipped disc", "pinched nerve", "degenerating disc", or other disc problem? Have any of your healthcare providers used one or several of these terms? Like many people, you may be unclear which disc condition you actually have and what the appropriate next steps are for dealing with it. This newsletter outlines things you can do to clear up the confusion about the most common painful disc conditions.

Understand Disc Problem Terminology

Why are disc problems so confusing? Among other reasons, different terms are used to describe a single spinal disc pathology (such as herniated disc, pinched nerve, or bulging disk). The actual term itself may be a bit of a misnomer. And different health professionals may use the terms differently or may not explain them well to you.

This confusion is demonstrated by two of the more common disc problems:

• Herniated disc. When someone has a herniated disc, the inner material of the disc leaks out or "herniates" out of this disc and irritates the adjacent nerve root. Seems pretty straightforward, except for the fact that this condition is also called bulging disc, ruptured disc, slipped disc, pinched nerve, sciatica, and more. Learn more in the following article: What's a herniated disc, pinched nerve, bulging disc, etc...?

• Degenerative disc disease. Think you understand this condition? A recent Spine-health poll showed that more than 80% of poll respondents do not. The term "degenerative" implies the condition will worsen with age, but the opposite is actually true. Also, degenerative disc disease is actually not really a "disease" at all. Learn more in the following article: What is degenerative disc disease?

Don't Assume the Pain Represents the Amount of Physical Damage

While it seems counterintuitive, one can't use the severity of back pain as a gauge for the degree of disc damage. A large herniated disc can be completely painless, while a disc with slight degeneration can produce severe back pain. And things like other physical and psychological factors (such as physical fitness or depression) shape an individual's pain experience, so it's difficult to generalize about pain among people who have the same disc problem. See the following article for more information: Pain generated by the spinal disc.

Get a Firm Back Pain Diagnosis

While radiographic findings (from a CT scan or MRI scan) are helpful, of greater importance in identifying the source of your pain are an accurate description of your symptoms and the results of the spine specialist's physical examination. Usually the key determination is whether your pain is from a pinched nerve or if the disc space itself is generating the pain. With a pinched nerve, the patient will likely experience "radicular pain" (also called nerve root pain, radiculopathy or sciatica). With pain from the disc itself, the patient usually experiences "referred pain" or "axial pain". Learn more in the following article: Understanding Low Back Pain (Lumbago).

Manage Disc Pain with Conservative Treatments

Keep in mind that most disc problems get better over time, without surgery, so it makes sense for patients to learn all they can about the various non-surgical treatment options available.

For a herniated disc, most patients should plan to follow a combination of the following conservative treatment options for the first six to eight weeks of discomfort and pain. If symptoms improve, continued conservative treatment is usually recommended:

• Physical therapy, exercise and gentle stretching to help relieve pressure on the nerve root
• Ice and heat therapy, manipulation (such as by a chiropractor), and/or pain medications for back pain relief
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil) or naproxen (e.g., Aleve) for pain relief.

For more severe pain flare-ups, oral steroids or epidural injections may be used to achieve a stronger anti-inflammatory effect. Learn more in Conservative treatments for a lumbar herniated disk.

Most patients with degenerative disc disease will experience low-grade continuous but tolerable pain that will occasionally intensify, then go back down again. To manage the pain, both the instability at the motion segment and inflammation from the degenerated discs need to be addressed, making exercise extremely critical for pain relief. Learn more in the following article:Low back pain and degenerative disc disease treatments.

Have Realistic Expectations for Pain Relief from Surgery

If conservative treatments do not alleviate the pain or restore the patient's level of functionality, surgery may be an option for pain from a disc problem.

For herniated discs, the surgical technique is commonly a removal of the herniating portion of the disc material to relieve the compression--called a microdiscectomy. Relief from leg pain is usually high with this surgery (90% or more), but relief of low back pain from surgery is much less predictable. Back surgery is unlikely to be successful if nerve compression isn't clearly documented on an MRI or CT scan. See the following article for more information: Microdiscectomy (microdecompression) spine surgery.

For a mechanical pain syndrome such as degenerative disc disease, the surgical technique recommended is usually a spinal fusion or artificial disc replacement. Fusion surgery is designed to stop the motion at a painful motion segment, and thereby reduce pain and improve function. Artificial disc replacement removes the painful disc. However, artificial disc surgery is only right for a subset of patients, and the newness of the procedure in the U.S. (Charite disc approved in October 2004) means there are more unknowns and cost reimbursement issues. Read more in Modern lumbar spine fusion surgery and Lumbar artificial disc surgery for chronic back pain.

Best wishes,
Peter F. Ullrich, Jr., MD, Medical Director
Stephanie Burke, President

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com.The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board.The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.