Signs and Symptoms
Symptoms depend on where the disc is and which nerve it touches:
- Lower back (lumbar) disc: back pain with pain, tingling or numbness down one leg (sciatica), sometimes weakness in the foot or ankle
- Neck (cervical) disc: neck pain with pain, tingling or numbness spreading into the shoulder blade, arm or hand, sometimes grip weakness
- Pain that increases with sitting, bending, coughing or sneezing
- Muscle spasms around the affected area
Some herniated discs cause no symptoms at all and are found by chance on an MRI.
What Causes It?
Spinal discs are cushions between the vertebrae (the bones of the spine). With age, discs lose water and become less flexible, so a small strain can cause the outer ring to tear. Lifting with a twist, repetitive bending, extra body weight, smoking and a family tendency toward disc problems all raise the risk. Often there is no single injury.
How We Diagnose It at POPB
Dr. Baskin takes your history and performs a neurological exam, checking strength, reflexes and sensation to find which nerve root is affected. If your symptoms and exam point to a disc herniation and you are not improving, or you have weakness, an MRI can confirm the size and location of the herniation. MRI and X-ray are available in our office.
Dr. Baskin compares the imaging with your exam, because disc changes on MRI are common and do not always explain symptoms.
Non-Surgical Treatment Options
Most people improve with conservative care, and in many cases the body gradually reabsorbs part of the herniated material over time. Treatment may include:
- Relative rest for a few days, then a gradual return to activity
- Physical therapy in our office, focused on core and neck stability, posture and nerve mobility. Therapists share your chart with Dr. Baskin.
- Anti-inflammatory or nerve pain medications when appropriate
- Epidural steroid injections, lumbar or cervical transforaminal, performed by Dr. Baskin with fluoroscopy guidance in our in-office procedure room to reduce inflammation around the nerve
Surgical Options
Surgery may be considered when there is significant or progressive weakness, when severe arm or leg pain continues despite several weeks of good non-surgical care, or in emergencies involving loss of bladder or bowel control. Common procedures remove the part of the disc pressing on the nerve. Dr. Baskin does not perform spine surgery; when it is worth considering, he refers you to a spine surgeon and shares your records and imaging.
Recovery
Many people see meaningful improvement within six to twelve weeks. Pain often eases before numbness or tingling. After an epidural injection, relief usually begins within several days, and the length of relief varies. A home exercise program from your physical therapist helps protect your spine going forward. Recovery times vary.
Insurance and Cost
Evaluation, MRI, physical therapy and epidural steroid injections are generally covered by Medicare and most commercial PPO plans when medically necessary, though many plans require prior authorization for MRI and injections. HMO and managed-care plans need a referral on file before your visit. Our staff verify your benefits when you call.
When to Be Seen
Call our office if arm or leg pain lasts more than a couple of weeks, if you have numbness or weakness, or if pain is keeping you from work or sleep.
Go to the emergency room or call 911 for loss of bladder or bowel control, numbness in the groin or inner thighs (saddle numbness), leg or arm weakness that is getting worse, fever with back or neck pain, or pain after a major trauma.
