Deformity

Deformity

The normal spine is structurally balanced for optimal flexibility and support of the body’s weight. When viewed from the side, it has three gentle curves. The lumbar (lower) spine has an inward curve called lordosis. The thoracic (middle) spine has an outward curve called kyphosis. The cervical spine (spine in the neck) also has a lordosis. These curves work in harmony to keep the body’s center of gravity aligned over the hips and pelvis. When viewed from behind, the normal spine is straight.

Abnormal curvature in the spine can put it out of alignment. Abnormal curvature seen from the side is called sagittal imbalance. Types of sagittal imbalance include kyphosis, flatback syndrome, and chin-on-chest syndrome. Abnormal curvature of the spine seen from the back is called scoliosis.

Each of these conditions can arise for a variety of reasons, including congenital deformity (deformity present at birth), age-related degeneration, disease processes like tumors or infections, other conditions, or idiopathic causes (causes that are not yet understood).

 

Glossary

 

Cervical: having to do with the spine in the neck. The normal cervical spine has a lordosis (inward curve)
Thoracic: having to do with the spine in the upper and mid-back. The normal thoracic spine has a kyphosis (outward curve)
Lumbar: having to do with the spine in the lower back. The normal lumbar spine has a lordosis (inward curve)
Congenital: present at birth
Degenerative: having to do with age-related wear-and-tear
Idiopathic: arising for unknown reasons
Sagittal deformity
Kyphosis: spinal deformity in which the spine curves excessively outward, creating the appearance of a hunchback. Occasionally called hyperkyphosis, to differentiate it from the normal kyphosis of the thoracic spine.
Chin on chest syndrome: cervical and upper thoracic kyphosis that is so severe the chin drops to the chest. Also referred to as dropped head syndrome or head ptosis.
Lordosis: a rare spinal deformity in which the lower back curves excessively inward. Occasionally called hyperlordosis to differentiate it from the normal lordosis of the lumbar spine. Hyperlordosis may occur to compensate for hyperkyphosis elsewhere.
Flatback syndrome: spinal deformity in which the lumbar spine loses its normal lordosis.
If deformities in the sagittal plane prevent the individual from achieving an upright posture with the head aligned over the hips, the result is sagittal imbalance.
Scoliosis: a side-to-side curve in the spine. Classifications include
Congenital: a form of scoliosis present at birth
Infantile: scoliosis that occurs in patients 0-3 years old
Juvenile: scoliosis that occurs in patients 4-10 years old
Adolescent: scoliosis that occurs in patients 11-18 years old
Adult: adult scoliosis may be idiopathic or degenerative in cause

 

Signs and Symptoms

 

Signs are observable indications of a condition. Signs can be seen or felt by people other than the patient. Signs of scoliosis may include a difference in shoulder or hip height, a difference in the way the arms hang beside the body, a spine that is visibly off-center, or a head that appears off-center with the body. Signs of sagittal imbalance may include a stooped forward posture, a hump in the back, or an inability to stand up straight.

Symptoms can be felt by the person with the condition. Symptoms of scoliosis vary: most cases of infantile, juvenile and adolescent scoliosis, for example, produce no symptoms. Degenerative scoliosis is often accompanied by pain. Symptoms of sagittal imbalance range from mild discomfort to severe pain. Spinal deformities also have the capacity to interfere with the spinal cord or nerve roots. Stretch or compression of the spinal cord or nerve roots produces symptoms that may include pain, weakness, numbness, or tingling that travel down an arm or a leg.

 

Treatments

 

For the most part, nonoperative treatments are recommended before surgery is considered. Nonoperative treatments include pain medications, physical therapy (including gait and posture training), and certain braces.

 

Surgery is considered if:

 

  • The patient experiences severe pain that is not relieved by physical therapy, bracing, and/or pain medications
  • The spinal deformity is progressing
  • The condition has caused a physical deformity that is unbearable to the patient
  • The condition has caused compression of the spinal cord or nerve roots
  • The deformity has resulted from fractures, usually caused by osteoporosis
  • The deformity is of such a magnitude that it is likely to progress even once skeletal growth is complete

The goals of surgery are to relieve symptoms and to align and stabilize the spine. However, since spinal deformity varies from patient to patient, no two surgical treatments will be the same. An experienced surgeon can determine the best treatment for each patient and each situation.

Aligning and stabilizing the spine are complex procedures. Spinal alignment must be achieved from all angles, and keeping the spine in its stable position often requires implanting hardware such as screws and rods.

Deformity

Deformity

The normal spine is structurally balanced for optimal flexibility and support of the body’s weight. When viewed from the side, it has three gentle curves. The lumbar (lower) spine has an inward curve called lordosis. The thoracic (middle) spine has an outward curve...

read more
Vertebral fracture

Vertebral fracture

Even minor falls or trauma can produce a spine fracture. Many of these injuries will never require surgery, but major fractures can result in serious long-term problems unless treated promptly and properly. Spine fractures range from painful compression fractures,...

read more
Segmental instability

Segmental instability

Each spinal segment is like a well-tuned part of a machine. All of the parts should work together to allow weight bearing, movement, and support. A spinal segment is composed of two vertebrae attached together by ligaments, with a soft disc separating them. The facet...

read more
Spinal stenosis

Spinal stenosis

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.Some people with spinal stenosis may not have symptoms. Others may...

read more
Disc herniation

Disc herniation

A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes...

read more

Vertebral fracture

Vertebral fracture

Even minor falls or trauma can produce a spine fracture. Many of these injuries will never require surgery, but major fractures can result in serious long-term problems unless treated promptly and properly. Spine fractures range from painful compression fractures, often seen after minor trauma in osteoporotic patients, to more severe injuries such as burst fractures and fracture-dislocations that occur following auto accidents or falls from height. These severe injuries frequently result in spinal instability, with a high risk of spinal cord injury and pain.

Osteoporosis, or weakening of the bones, can lead to painful vertebral compression fractures. Until recently the only treatment was bracing and narcotic medications which frequently lead to ongoing pain and progressive deformity. The spinal surgeons at Cleveland Clinic Center for Spine Health can now, using a new technology, re-expand the vertebral body (kyphoplasty) and augment its strength by injecting bone cement. This can be done as an outpatient in a minimally invasive fashion. In other cases cement injection without re-expansion of the fracture (vertebroplasty) can be performed.

 

What causes the fracture?

 

When an external force is applied to the spine, such as from a fall, the forces may exceed the ability of the bone within the vertebral column to support the load. This may cause the front part of the vertebral body to crush, resulting in a compression fracture. If the entire vertebral column breaks, it results in a burst fracture.

If the compression is mild, you will experience only mild pain and minimal deformity. If the compression is severe, affecting the spinal cord or nerve roots, you will experience severe pain and a hunched forward deformity (kyphosis).

Osteoporosis is the most common risk factor for fractures, as the disease causes bones to weaken.

 

What are the treatment options?

 

Medical Treatment

 

Most fractures are treated with immobilization in a brace or corset for up to 12 weeks. Bracing helps to reduce pain and prevent deformity.

 

Surgical Treatment

 

Severe cases may require surgery.

Vertebroplasty is a new surgical procedure that may be used to treat compression fractures. In this procedure, the surgeon inserts a catheter into the compressed vertebra. The catheter is used to inject the fractured vertebrae with bone cement, which hardens, stabilizing the vertebral column. This procedure has been shown to reduce or eliminate fracture pain, enabling a rapid return to mobility and preventing bone loss due to bed rest. However, it does not correct the spinal deformity.

Kyphoplasty involves inserting a tube into the vertebral column under X-ray guidance, followed by the insertion of an inflatable bone tamp. A tiny incision is made in the back. Once inflated, the tamp restores the vertebral body back toward its original height, while creating a cavity to be filled with bone cement. The cement seals off cracks and cavities, and prevents the vertebra from re-collapsing. After the cavity is filled, the tube is removed and the incision stitched. Since August 1998, hundreds patients have been treated at The Cleveland Clinic with kyphoplasty.

Stabilization can also be achieved by removing broken vertebra and replacing them with a plate, screws, or cage. Beyond the traditional open surgical approaches, there are also minimally invasive(percutaneous) stabilization technique for spinal fratcure treatment.

What are the risks of surgery? Is the surgery safe?

 

Risks of surgery include nerve injury, infection, bleeding, and stiffness. Surgical complication rate can be reduced by applying minimally invasive spinal fracture stabilization techniques.

Deformity

Deformity

The normal spine is structurally balanced for optimal flexibility and support of the body’s weight. When viewed from the side, it has three gentle curves. The lumbar (lower) spine has an inward curve called lordosis. The thoracic (middle) spine has an outward curve...

read more
Vertebral fracture

Vertebral fracture

Even minor falls or trauma can produce a spine fracture. Many of these injuries will never require surgery, but major fractures can result in serious long-term problems unless treated promptly and properly. Spine fractures range from painful compression fractures,...

read more
Segmental instability

Segmental instability

Each spinal segment is like a well-tuned part of a machine. All of the parts should work together to allow weight bearing, movement, and support. A spinal segment is composed of two vertebrae attached together by ligaments, with a soft disc separating them. The facet...

read more

Segmental instability

Segmental instability

Each spinal segment is like a well-tuned part of a machine. All of the parts should work together to allow weight bearing, movement, and support. A spinal segment is composed of two vertebrae attached together by ligaments, with a soft disc separating them. The facet joints fit between the two vertebrae, allowing for movement, and the foramen between the vertebrae allows space for the nerve roots to travel freely from your spinal cord to the rest of your body. When all the parts are functioning properly, the spinal segments join to make up a remarkably strong structure called the spine. When one segment deteriorates to the point of instability, it can lead to localized pain and difficulties.

Segmental instability occurs when there is too much movement between two vertebrae in your spine. The excess movement of the vertebrae can cause pinching or irritation of nerve roots. It can also cause too much pressure on your facet joints, leading to inflammation of facet joints. It also may cause muscle spasms as the paraspinal muscles in your back try to stop the spinal segment from moving too much. The instability eventually results in faster degeneration of your spine in this area.

Causes

Your spine is stabilized by an intricate set of systems working in concert to both limit and allow flexibility in your spine. These systems are:

The passive system – which includes your vertebrae, facet joints, intervertebral discs, and ligaments. This system stabilizes your spine when you bend and twist.
The active system – which includes the muscles and tendons that are attached to your spine. This system stabilizes your spine when it is in the neutral zone (neither bent nor twisted).
The neural system – which includes the nerves that control the muscles in your spine. This system receives input from the other systems to determine what your spine requires to maintain stability when it is in motion and when it is neutral.
These 3 systems of spinal stability must work together at all times to keep your spine strong and safe. If a problem occurs in any one of the systems, such as a fractured vertebra, a herniated disc, a muscle strain or tendon sprain, or a pinched nerve (called radiculopathy), this puts added stress on the remaining systems to keep your spine stable.

It is hard to determine which problem comes first in segmental instability. In some cases, degeneration of a disc in your spine begins the process. Once the disc is no longer able to function normally, the degeneration process of ALL parts of the spinal segment begins. As your disc continues to degenerate, the facet joints become arthritic, bone spurs form around the joints, and the segmental instability gets worse. This cycle continues until it is corrected.

Segmental instability of your spine can also result post-operatively after spinal surgery and after trauma to your spine. It can also be caused by other conditions including scoliosis, infection, and tumors.

Symptoms

Low back pain is a common symptom reported by up to 30% of patients with segmental instability. The pain you feel when you have segmental instability may be chronic, which means you feel it all the time, or it may recur either with certain movements or when you hold your back still. The pain may come on suddenly and in response to a movement that normally would not be painful. You may also feel like popping or cracking your back would make the pain feel better. If you have segmental instability, you may also feel like your back is weak, or that it catches or locks when you move.

Diagnosis

The first step in diagnosing segmental instability is to perform a complete history and physical exam. Your doctor may ask you about your history of low back pain and back trauma and how it has been treated in the past. During the physical exam your doctor will check how your back works through various types of motion. To diagnose your back problem, your doctor may also ask you to wear a back brace for awhile to see whether it provides relief of your symptoms. If the brace provides pain relief, this suggests you may have segmental instability.

Diagnosing segmental instability can be difficult because there is not a agreed standard on what other types of diagnostic tests to perform. This is because radiologic tests cannot show how your spine works throughout the entire range of motion.

Your doctor will likely take X-rays of your spine in the neutral position (standing straight) and at different degrees of flexion. X-rays will show your doctor the amount of space between your facet joints and the condition of your vertebrae. Other diagnostic tests your doctor may perform include a CT scan to get a better look at your vertebrae and facet joints including any bone spurs that may be present. An MRI may also be ordered to check for lesions such as a herniated disc. Your doctor may also order an electromyogram (EMG) of your spine to check for signs of segmental instability.

Treatment Options

Conservative Treatment

If you have been diagnosed with segmental instability, your doctor will likely recommend conservative treatment to start. Conservative treatments for segmental instability include the use of a brace to support and stabilize your spine. Your doctor will also likely recommend physical therapy including stabilization exercises to strengthen and control the muscles in your spine, and education about how to protect your spine during everyday activities.

Surgical Treatment

Surgery to correct segmental instability is usually reserved for patients with severe spinal disability after conservative treatment has failed to provide adequate relief. Spinal fusion may be recommended if one of the vertebra in your spine is able to move out of alignment by more than 4 mm (millimeters) or if the vertebra is able to rotate 10 degrees or more compared to the other vertebrae in your spine. Spinal fusion will correct the instability in your spine by permanently connecting the unstable segment to the stable segment above or below it.

Deformity

Deformity

The normal spine is structurally balanced for optimal flexibility and support of the body’s weight. When viewed from the side, it has three gentle curves. The lumbar (lower) spine has an inward curve called lordosis. The thoracic (middle) spine has an outward curve...

read more
Vertebral fracture

Vertebral fracture

Even minor falls or trauma can produce a spine fracture. Many of these injuries will never require surgery, but major fractures can result in serious long-term problems unless treated promptly and properly. Spine fractures range from painful compression fractures,...

read more
Segmental instability

Segmental instability

Each spinal segment is like a well-tuned part of a machine. All of the parts should work together to allow weight bearing, movement, and support. A spinal segment is composed of two vertebrae attached together by ligaments, with a soft disc separating them. The facet...

read more
Spinal stenosis

Spinal stenosis

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.Some people with spinal stenosis may not have symptoms. Others may...

read more
Disc herniation

Disc herniation

A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes...

read more
Spinal stenosis

Spinal stenosis

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.
Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time.
Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Types of spinal stenosis

The types of spinal stenosis are classified according to where on the spine the condition occurs. It’s possible to have more than one type. The two main types of spinal stenosis are:
Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck.
Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis.

Symptoms

Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.
In the neck (cervical spine)
Numbness or tingling in a hand, arm, foot or leg
• Weakness in a hand, arm, foot or leg
• Problems with walking and balance
• Neck pain
• In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)
In the lower back (lumbar spine)
Numbness or tingling in a foot or leg
• Weakness in a foot or leg
• Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
• Back pain

When to see a doctor
See your doctor if you have any of the symptoms listed. (Request an appointment with Dr. Lazary)

Causes

The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord (nerves).
Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include:
Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
Herniated disks. The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
Tumors. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.

Risk factors

Most people with spinal stenosis are over the age of 50. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. These include trauma, congenital spinal deformity such as scoliosis, and a genetic disease affecting bone and muscle development throughout the body. Spinal imaging can differentiate these causes.

Complications

Rarely, untreated severe spinal stenosis may progress and cause permanent:
Numbness
• Weakness
• Balance problems
• Incontinence
• Paralysis

Treatment

Treatment for spinal stenosis depends on the location of the stenosis and the severity of your signs and symptoms. Surgery may be an option if other treatments haven’t helped.
 The goals of surgery include relieving the pressure on your spinal cord or nerve roots by creating more space within the spinal canal. Surgery to decompress the area of stenosis is the most definitive way to try to resolve symptoms of spinal stenosis.
Research shows that spine surgeries result in fewer complications when done by highly experienced surgeons. Don’t hesitate to ask about your surgeon’s experience with spinal stenosis surgery. If you have any doubts, get a second opinion.
Examples of surgical procedures to treat spinal stenosis include:
Decompression/Laminotomy. This procedure removes only a portion of the lamina, typically carving a hole just big enough to relieve the pressure in a particular spot.
Laminoplasty. This procedure is performed only on the vertebrae in the neck (cervical spine). It opens up the space within the spinal canal by creating a hinge on the lamina. Metal hardware bridges the gap in the opened section of the spine.
 Fusion. If spinal stenosis is complicated with segmental instability or extended decompression leads to the instability of the segment, the stabilization (fusion) of the vertebrae is indicated.
Minimally invasive surgery. This approach to decompression surgery removes bone or lamina in a way that reduces the damage to nearby healthy tissue. This results in less need to do fusions. Fusion procedures can be also done with one of the minimally invasive stabilization techniques. A minimally invasive approach to surgery has been shown to result in a shorter recovery time.

Deformity

Deformity

The normal spine is structurally balanced for optimal flexibility and support of the body’s weight. When viewed from the side, it has three gentle curves. The lumbar (lower) spine has an inward curve called lordosis. The thoracic (middle) spine has an outward curve...

read more
Vertebral fracture

Vertebral fracture

Even minor falls or trauma can produce a spine fracture. Many of these injuries will never require surgery, but major fractures can result in serious long-term problems unless treated promptly and properly. Spine fractures range from painful compression fractures,...

read more
Segmental instability

Segmental instability

Each spinal segment is like a well-tuned part of a machine. All of the parts should work together to allow weight bearing, movement, and support. A spinal segment is composed of two vertebrae attached together by ligaments, with a soft disc separating them. The facet...

read more
Spinal stenosis

Spinal stenosis

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.Some people with spinal stenosis may not have symptoms. Others may...

read more
Disc herniation

Disc herniation

A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes...

read more
Disc herniation

Disc herniation

A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine.

A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior.

A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don’t need surgery to correct the problem.

 

Symptoms

 

Most herniated disks occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine). The most common signs and symptoms of a herniated disk are:

Arm or leg pain. If your herniated disk is 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 your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.
Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
You also can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem.

When to see a doctor
Seek medical attention if your neck or back pain travels down your arm or leg, or if it’s accompanied by numbness, tingling or weakness. (Request an appointment with Dr. Lazary)

 

Causes

 

Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Most people can’t pinpoint the exact cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.

Risk factors
Factors that increase your risk of a herniated disk may include:

Weight. Excess body weight causes extra stress on the disks in your lower back.
Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disk.
Genetics. Some people inherit a predisposition to developing a herniated disk.

 

Complications

 

Your spinal cord doesn’t extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse’s tail. Rarely, disk herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.

Seek emergency medical attention if you have:

Worsening symptoms. Pain, numbness or weakness may increase to the point that you can’t perform your usual daily activities.
Bladder or bowel dysfunction. People who have cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.

Prevention
To help prevent a herniated disk:

Exercise. Strengthening the trunk muscles helps stabilize and support the spine.
Maintain good posture. Good posture reduces the pressure on your spine and disks. Keep your back straight and aligned, particularly when sitting for long periods. Lift heavy objects properly, making your legs — not your back — do most of the work.
Maintain a healthy weight. Excess weight puts more pressure on the spine and disks, making them more susceptible to herniation.

 

Treatment

 

Medications

 

Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).
Narcotics. If your pain doesn’t improve with over-the-counter medications, your doctor might prescribe narcotics, such as codeine or an oxycodone-acetaminophen combination (Percocet, OxyContin, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs.
Anticonvulsants. Drugs originally designed to control seizures also may be helpful in the treatment of the radiating nerve pain often associated with a herniated disk.
Muscle relaxers. Muscle relaxants may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects of these medications.
Cortisone injections. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves. Spinal imaging can help guide the needle more safely. Occasionally a course of oral steroids may be tried to reduce swelling and inflammation.

 

Physical Therapy

 

If your pain has not resolved within a few weeks, your doctor may suggest physical therapy. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.

 

Surgery

 

A very small number of people with herniated disks eventually need surgery. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after four-six weeks, especially if you continue to experience:
Numbness or weakness
Difficulty standing or walking
Loss of bladder or bowel control

In many cases, surgeons can remove just the protruding portion of the disk (microdiscectomy). Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability (spinal fusion). Rarely, your surgeon may suggest the implantation of an artificial disk (artificial disc replacement).

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