Herniated Discs: Maimonides Has Your Back
Herniated discs can cause patients tremendous pain. Listen to Dr. Ahmed Saleh's advice. Dr. Saleh is an orthopedic surgeon at The Bone & Joint Center at Maimonides Health, one of America’s 100 Best Hospitals for Orthopedic Surgery, according to Healthgrades.
Featured Speaker:
Ahmed Saleh, MD
Dr. Saleh specializes in the treatment of neck and back disorders for both adolescents and adults, with a special interest in spinal deformities such as scoliosis and kyphosis, spinal trauma, and degenerative diseases of the neck and back. A native New Yorker, Dr. Saleh is a member of the American Academy of Orthopaedic Surgeons, National Association of Spine Surgeons, America Orthopaedic Association, and Brooklyn Orthopaedic Society. He has published and contributed to numerous articles in leading journals, including Primary Care: Clinics in Office Practice, Journal of Spine, Ultrasound Clinics, and Global Spine Journal. Transcription:
Herniated Discs: Maimonides Has Your Back
Caitlin Whyte: A herniated disc is a painful, frustrating, but quite common problem. So to tell us more about this back and neck pain, we are joined by Dr. Ahmed Saleh, an orthopedic spine surgeon at the Bone and Joint Center at Maimonides. One of America's 100 best hospitals, four orthopedic surgery, according to health grades. This is my Maimo MedTalk. I'm your host, Caitlin Whyte. So doctor let's start simple today. If we are diagnosed with a herniated disc, what does that mean? What has happened in our body?
Dr. Ahmed Saleh: Well, I like to explain herniated discs to my patients by first explaining that the spine is made up of a lot of different bones. And in between the bones of the spine, there's a disc that kind of works as a shock absorber. And sometimes in some patients, this shock absorber or disc can move slightly out of place. And if it moves out of place that sometimes could cause pain or it could cause pressure on an adjacent nerve in the area, which could also cause pain kind of either down the leg or the arm, depending on where the disc herniation is.
So patients will often refer to things such as bulges or herniations. And they're kind of ways that we describe these discs on imaging. And essentially it means that there's the disc that is slightly out of place from where it should.
Caitlin Whyte: Well, that kind of leads me into my next question. Can you tell us about the specific symptoms of a herniated disc? How would we know this is not just regular back or neck strain?
Dr. Ahmed Saleh: Yeah. So herniated discs can cause a very. Broad spectrum of symptoms, depending on the severity of the herniation and also the location of the herniation. So a minor disc bulge or minor disc herniation could sometimes just cause pure either neck or back pain. But if it starts in pinging on the nerves in the lower back, it could cause things like lower back spasms. It could also cause things of what we call a ridiculopathy, which means that you'll have radiating shooting pain down the leg, or even numbness or tingling in the leg from nerve compression that's possible.
And sometimes if it's a very, very massive disc herniation in the lower back, it could even cause more severe symptoms, things bowel or bladder dysfunction is even possible from disc herniations in the neck. It could also cause different issues of radiculopathy in the neck. Meaning nerve compression to neck could cause radiated of pain down the arm or numbness and tingling in the hand. But a disc herniation to neck could also cause spinal cord compression which could also create a constellation of symptoms, which we refer to as myopathy. Which could include things like changes in fine motor control, gate instability, or even upper lower extremity weakness.
Caitlin Whyte: On that note, when should we reach out to a doctor and what goes into diagnosing this?
Dr. Ahmed Saleh: Yeah. So I think anytime you are experiencing persistent pain in the neck or the back, I think it's worth, always to talk to your primary doctor about that. Usually the primary doctors can work this up or even send you for treatment. Initially, I think it's important to see a surgeon when those symptoms become persistent, despite other treatments. I think that if you are having severe pain, that is unrelenting, then certainly it's worth seeing a surgeon. If you're having any weakness, any severe numbness or tingling, or even severe neurological symptoms, such as bowel or bladder dysfunction.
Those are times that you should either go to the emergency emergency. Surgeon now in terms of diagnosis, diagnosis can be pretty straightforward for disc herniations. The gold standard to really diagnose a disc herniation would be to obtain an MRI of either the neck or the back depending on where the symptoms are. An MRI does a great job at showing us all the discs in the back and also all the nerves. So we're able to tell if there is any pressure on the nerve.
Caitlin Whyte: Well, I'm sure our listeners are waiting to hear about some treatment options. So what can we do at home or just in the office to ease the pain and possibly fix a herniated disc?
Dr. Ahmed Saleh: In terms of treatment, the vast majority of patients are treated non-operatively with disc herniations, more than 80% of people with the disc herniations don't require any type of surgical intervention. So most of the patients are treated non-operatively. Now it's simple things. Initially we start things like anti-inflammatory medications that are over the counter and these can help decrease inflammation and pain. Other things that we recommend are stretching exercises or physical therapy in order to help with the pain and the symptoms.
And these are kind of focused usually to do things like heat and massage and stretching and nerve gliding exercises to help decrease the patient's symptoms. And most of the time that does alleviate the patient symptoms. It could take time. For these things to improve, I would say that patients should try physical therapy for at least six weeks or so. Those are probably some of the best at home treatments that you could do before trying anything invasive.
Caitlin Whyte: And if these options aren't working, what would our next steps be?
Dr. Ahmed Saleh: Yeah. Well, if your pain and symptoms, haven't really improved with things like anti-inflammatory medications and physical therapy. If at that point you still haven't gotten an MRI. At that point I do recommend imaging of the back in order to kind of get a more definitive diagnosis as to where exactly the disc herniation is in where it's coming from. And once we are able to identify the exact area of the disc herniation and where it's coming from, we usually will work together with our pain management colleagues and refer the patient for what we call a epidural injection.
And these injections are cortisone injections focused around the area where the nerve is being compressed. And this can often time help alleviate both the back pain as well as the ridicular symptom, which pain shooting down the leg. That often time also helps significantly reduce the patient's pain and symptoms. Obviously, if the injections over time do not help sometimes surgical management has to be considered at that point. If the non-surgical treatment options aren't working and surgery has to be considered, surgery could vary significantly between either the neck or the lower back.
Sometimes surgery could be a very small, minor procedure. What we call a lumbar microdisectomy, where we make about an inch incision, go down to the nerve, free up the nerve, make more room for the nerve and pull out the disc herniation that's causing the pressure on the nerve. Sometimes in the neck, that's not possible. So in the neck, we have to go in through the front of the neck oftentimes and remove the entire disc and then either do what's called a disc replacement or a disc fusion at that level. So the treatments can change, but the surgical treatments for either the neck and the back do work very reliably to help alleviate patient's pain and symptom.
Caitlin Whyte: Doctor as we wrap up here, you know, my boyfriend has a herniated disc and it's really changed his life. He's getting treatments, but recovery is still so far away. Any final thoughts for people listening, who may be struggling with this now?
Dr. Ahmed Saleh: Yeah, I think my recommendation would be to certainly listen to your doctors and listen to your therapists and kind of work closely with them. I think some people have a misconception that something like back pain or disc herniation will just last a week or two and improve over time. My recommendation is to be patient, that these things do take quite a long time, sometimes in some patients to resolve and improve. But like I mentioned, the VA majority of patients don't need surgery and improve with time.
So that I think is very important to note. I would also tell him that if he hasn't yet seen someone who is a spine surgeon or specialist, and he has persistent pain despite treatment, I think it's worth getting your back checked out. Because it's very important to get an accurate diagnosis in order to know what exactly is going on and how to treat it best.
Caitlin Whyte: Well, doctor, thank you so much for your time and work in helping people with these issues. I know this episode will help so, so, many. For more information, you can visit maimo.org or call 718-283-7400 to make an appointment with Dr. Saleh. This has been Maimo Med Talk. I'm your host, Caitlin Whyte, stay well.
Herniated Discs: Maimonides Has Your Back
Caitlin Whyte: A herniated disc is a painful, frustrating, but quite common problem. So to tell us more about this back and neck pain, we are joined by Dr. Ahmed Saleh, an orthopedic spine surgeon at the Bone and Joint Center at Maimonides. One of America's 100 best hospitals, four orthopedic surgery, according to health grades. This is my Maimo MedTalk. I'm your host, Caitlin Whyte. So doctor let's start simple today. If we are diagnosed with a herniated disc, what does that mean? What has happened in our body?
Dr. Ahmed Saleh: Well, I like to explain herniated discs to my patients by first explaining that the spine is made up of a lot of different bones. And in between the bones of the spine, there's a disc that kind of works as a shock absorber. And sometimes in some patients, this shock absorber or disc can move slightly out of place. And if it moves out of place that sometimes could cause pain or it could cause pressure on an adjacent nerve in the area, which could also cause pain kind of either down the leg or the arm, depending on where the disc herniation is.
So patients will often refer to things such as bulges or herniations. And they're kind of ways that we describe these discs on imaging. And essentially it means that there's the disc that is slightly out of place from where it should.
Caitlin Whyte: Well, that kind of leads me into my next question. Can you tell us about the specific symptoms of a herniated disc? How would we know this is not just regular back or neck strain?
Dr. Ahmed Saleh: Yeah. So herniated discs can cause a very. Broad spectrum of symptoms, depending on the severity of the herniation and also the location of the herniation. So a minor disc bulge or minor disc herniation could sometimes just cause pure either neck or back pain. But if it starts in pinging on the nerves in the lower back, it could cause things like lower back spasms. It could also cause things of what we call a ridiculopathy, which means that you'll have radiating shooting pain down the leg, or even numbness or tingling in the leg from nerve compression that's possible.
And sometimes if it's a very, very massive disc herniation in the lower back, it could even cause more severe symptoms, things bowel or bladder dysfunction is even possible from disc herniations in the neck. It could also cause different issues of radiculopathy in the neck. Meaning nerve compression to neck could cause radiated of pain down the arm or numbness and tingling in the hand. But a disc herniation to neck could also cause spinal cord compression which could also create a constellation of symptoms, which we refer to as myopathy. Which could include things like changes in fine motor control, gate instability, or even upper lower extremity weakness.
Caitlin Whyte: On that note, when should we reach out to a doctor and what goes into diagnosing this?
Dr. Ahmed Saleh: Yeah. So I think anytime you are experiencing persistent pain in the neck or the back, I think it's worth, always to talk to your primary doctor about that. Usually the primary doctors can work this up or even send you for treatment. Initially, I think it's important to see a surgeon when those symptoms become persistent, despite other treatments. I think that if you are having severe pain, that is unrelenting, then certainly it's worth seeing a surgeon. If you're having any weakness, any severe numbness or tingling, or even severe neurological symptoms, such as bowel or bladder dysfunction.
Those are times that you should either go to the emergency emergency. Surgeon now in terms of diagnosis, diagnosis can be pretty straightforward for disc herniations. The gold standard to really diagnose a disc herniation would be to obtain an MRI of either the neck or the back depending on where the symptoms are. An MRI does a great job at showing us all the discs in the back and also all the nerves. So we're able to tell if there is any pressure on the nerve.
Caitlin Whyte: Well, I'm sure our listeners are waiting to hear about some treatment options. So what can we do at home or just in the office to ease the pain and possibly fix a herniated disc?
Dr. Ahmed Saleh: In terms of treatment, the vast majority of patients are treated non-operatively with disc herniations, more than 80% of people with the disc herniations don't require any type of surgical intervention. So most of the patients are treated non-operatively. Now it's simple things. Initially we start things like anti-inflammatory medications that are over the counter and these can help decrease inflammation and pain. Other things that we recommend are stretching exercises or physical therapy in order to help with the pain and the symptoms.
And these are kind of focused usually to do things like heat and massage and stretching and nerve gliding exercises to help decrease the patient's symptoms. And most of the time that does alleviate the patient symptoms. It could take time. For these things to improve, I would say that patients should try physical therapy for at least six weeks or so. Those are probably some of the best at home treatments that you could do before trying anything invasive.
Caitlin Whyte: And if these options aren't working, what would our next steps be?
Dr. Ahmed Saleh: Yeah. Well, if your pain and symptoms, haven't really improved with things like anti-inflammatory medications and physical therapy. If at that point you still haven't gotten an MRI. At that point I do recommend imaging of the back in order to kind of get a more definitive diagnosis as to where exactly the disc herniation is in where it's coming from. And once we are able to identify the exact area of the disc herniation and where it's coming from, we usually will work together with our pain management colleagues and refer the patient for what we call a epidural injection.
And these injections are cortisone injections focused around the area where the nerve is being compressed. And this can often time help alleviate both the back pain as well as the ridicular symptom, which pain shooting down the leg. That often time also helps significantly reduce the patient's pain and symptoms. Obviously, if the injections over time do not help sometimes surgical management has to be considered at that point. If the non-surgical treatment options aren't working and surgery has to be considered, surgery could vary significantly between either the neck or the lower back.
Sometimes surgery could be a very small, minor procedure. What we call a lumbar microdisectomy, where we make about an inch incision, go down to the nerve, free up the nerve, make more room for the nerve and pull out the disc herniation that's causing the pressure on the nerve. Sometimes in the neck, that's not possible. So in the neck, we have to go in through the front of the neck oftentimes and remove the entire disc and then either do what's called a disc replacement or a disc fusion at that level. So the treatments can change, but the surgical treatments for either the neck and the back do work very reliably to help alleviate patient's pain and symptom.
Caitlin Whyte: Doctor as we wrap up here, you know, my boyfriend has a herniated disc and it's really changed his life. He's getting treatments, but recovery is still so far away. Any final thoughts for people listening, who may be struggling with this now?
Dr. Ahmed Saleh: Yeah, I think my recommendation would be to certainly listen to your doctors and listen to your therapists and kind of work closely with them. I think some people have a misconception that something like back pain or disc herniation will just last a week or two and improve over time. My recommendation is to be patient, that these things do take quite a long time, sometimes in some patients to resolve and improve. But like I mentioned, the VA majority of patients don't need surgery and improve with time.
So that I think is very important to note. I would also tell him that if he hasn't yet seen someone who is a spine surgeon or specialist, and he has persistent pain despite treatment, I think it's worth getting your back checked out. Because it's very important to get an accurate diagnosis in order to know what exactly is going on and how to treat it best.
Caitlin Whyte: Well, doctor, thank you so much for your time and work in helping people with these issues. I know this episode will help so, so, many. For more information, you can visit maimo.org or call 718-283-7400 to make an appointment with Dr. Saleh. This has been Maimo Med Talk. I'm your host, Caitlin Whyte, stay well.