Disc Herniation Demystified: Innovative Approaches to Relief

Disc herniation occurs when the nucleus pulposus (the jelly-like center of a spinal disc) breaks through the annulus fibrosus (the tough, rubbery exterior ring) due to age-related wear and tear or a sudden injury. This can compress nearby nerves and result in pain, numbness, or weakness along the nerve pathway.

Symptoms:

Symptoms can include arm or leg pain, depending on the location of the herniated disc. If it’s in your lower back, you’ll typically feel the most intense pain in your buttocks, thigh, and calf. It may also involve part of the foot. If the herniated disc is in your neck, the pain will be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze, or move into certain positions.

Treatment Options:

Epidural Steroid Injections: Epidural Steroid Injections (ESIs) are a common and effective treatment for reducing inflammation and alleviating pain caused by disc herniations. These injections involve the delivery of corticosteroids and an anesthetic directly into the epidural space—the area outside the dural membrane that surrounds the spinal cord and nerves. Corticosteroids are potent anti-inflammatory agents that can rapidly reduce swelling and inflammation around the nerves affected by the herniated disc, thus alleviating pain and other symptoms such as numbness and weakness. The process is guided by fluoroscopy or CT imaging to ensure accuracy, maximizing the therapeutic effect while minimizing risks. 

This treatment is particularly beneficial for patients experiencing acute radicular pain (sciatica) due to herniated lumbar discs. While not a cure for the underlying herniation, epidural steroid injections can provide significant pain relief for extended periods, allowing patients to progress with physical therapy and resume normal activities more comfortably. The injections may be repeated if the initial response is favorable but are typically limited to a few per year to avoid potential side effects from corticosteroids.

Nerve Blocks: Nerve blocks, specifically selective nerve root blocks (SNRBs), are another effective intervention for managing pain associated with disc herniations. These injections target specific nerve roots that are irritated or compressed due to the herniated disc material. By injecting a local anesthetic and a steroid directly near the affected nerve root, a nerve block can provide immediate relief from pain by numbing the area and reducing inflammation. 

Nerve blocks are particularly useful not only for pain relief but also as a diagnostic tool. By temporarily relieving pain, they help confirm the specific spinal nerve root that is causing the problem, thereby guiding further treatment. For example, if a patient experiences complete pain relief following a nerve block at a certain level, it confirms that the herniated disc at that level is the source of pain. 

Moreover, like epidural steroid injections, nerve blocks can improve a patient’s ability to engage in other therapeutic interventions such as physical therapy by providing pain relief. However, the duration of pain relief from nerve blocks can vary significantly among individuals, and additional treatments may be necessary to manage the condition long-term.

Dealing with disc herniations can be challenging, but Dr. Goel is here to help. Schedule your consultation today to discuss your treatment options.