Disk Herniation

Excerpt

Herniated nucleus pulposus (HNP) is a common cause of back pain resulting from the displacement of the nucleus pulposus from its normal position within the intervertebral space. Patients often experience pain and recall an event that triggered the condition. Unlike mechanical back pain, herniated disk–related pain is typically characterized by a burning or stinging sensation and may radiate into the extremities. In severe cases, the herniation is associated with weakness, sensory abnormalities, and bowel and bladder dysfunction. The nucleus pulposus supports the spine by acting as a shock-absorbing cushion. In some instances, a herniated disk can compress the nerve or the spinal cord, causing pain, symptoms of nerve compression, or spinal cord dysfunction, also known as myelopathy.

Unfortunately, effective conservative treatment options for HNP are limited. However, most cases of disk herniation resolve in a few weeks. Furthermore, a disk herniation may be asymptomatic and discovered incidentally on an MRI. Imaging studies are not indicated in a patient without red flag signs unless symptoms persist for 6 weeks, and MRI is the imaging modality of choice. Most herniated disks improve with conservative treatment, but refractory cases may require interventional or surgical repair. Epidural corticosteroid injections are effective for short-term pain management of a disk herniation. Surgical diskectomy is more effective than conservative management during the first year of symptoms; surgical intervention is less effective after 1 year. Clinicians should monitor for severe or rapidly progressing neurological changes, as this would indicate urgent neurosurgical referral.