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Lumbar Disc Herniation
One of the most common causes of lower back pain is a herniated disc. Dr. Esteban Cuartas discusses how to identify and treat lumbar disc herniation.
Featured Speaker:
Esteban Cuartas, MD
Dr. Esteban Cuartas is an orthopedic surgeon in Monroe, New York and is affiliated with St. Luke's Cornwall Hospital. He received his medical degree from Institute of Health Sciences Medellin Faculty of Medicine. Transcription:
Lumbar Disc Herniation
Amanda Wilde (Host): One of the most common causes of lower back pain is a herniated disc. So today we're talking about how to identify and treat lumbar disc herniation with orthopedic spine surgeon, Dr. Esteban, Cuartas. Welcome to Doc Talk presented by Montefiore St. Luke's Cornwall. I'm Amanda Wilde. Dr. Cuartas. Welcome to the podcast.
Dr Esteban Cuartas: Thank you.
Amanda Wilde (Host): Lower back pain is incredibly common. Isn't it?
Dr Esteban Cuartas: Absolutely. Lower back pain accounts for huge proportion of hospital and doctor office visits every year in the United States.
Amanda Wilde (Host): We've talked previously in another podcast about lumbar stenosis, another lower back problem. So how do you detect a herniated disc? Is it different symptoms?
Dr Esteban Cuartas: So within the larger group of patients with acute back pain, are patients that have damaged disc, because they do include, clinically, patients with annular tears, which are tears of the outside ring of the disc. And patients that have a more formal herniation in which the outside contour of the disc is bulging out or ruptured completely. So the way we diagnose these is with, the clinical, physical exam, as well as imaging, which would mostly be MRI.
Amanda Wilde (Host): So when someone comes in with an issue at their lower back, this might be something you'd suspect since it's so common. And we should mention that ruptured and bulging discs are the same. Are they not as lumber disc herniation?
Dr Esteban Cuartas: I try to use different words to describe the different situations. So to explain on the clinical side, the patients may present very similarly either with just very severe and disabling back pain. But they may actually have different, pictures once we look at the MRI. The other component of this is whether or not they have a lot of sciatica type pain, which is pain going down a leg. some patients can have just back pain and no sciatica, but have a very clear large disc herniation on the MRI. So, they sort of use the term for, disc herniation clinical syndrome, to describe the presentation, but then I try to refine it for further understanding for the patients once we're looking at the MRI pictures.
Amanda Wilde (Host): Once you've determined, there is a disc herniation, how do you treat that?
Dr Esteban Cuartas: There's a very broad range of things that we, can do. We can prescribe a little bit of rest from, certain activities. Say, if work is very physical. We can prescribe anti-inflammatories as well as muscle relaxants. And sometimes anti-inflammatory steroid medication, which are also, usually called, prednisone or cortisone. We can also prescribe physical therapy is, helpful in some cases. And, finally we can also, prescribe more invasive treatments, including injections, and sometimes surgery is required to help patients improve their pain.
Amanda Wilde (Host): So it sounds like with rest and proper treatment of your body, you may recover from a herniated disc over time. You may not have to go to surgery?
Dr Esteban Cuartas: Yes. I would say somewhere between 80 to 90% of patients that have a damaged disc or herniated disc, can recover without surgery.
Amanda Wilde (Host): Well, that's encouraging. What can we do to prevent getting a herniated disc or does this commonly, it's so common, does it just happen over time?
Dr Esteban Cuartas: Some of the factors that lead to discrimination include lifting with Poor technique. So either lifting things that are just too heavy for your body frame or lifting with poor technique, which would be the basic three things are lifting while leaning forward or lifting heavy things and twisting your body, as opposed to keeping your body rigid. And the last one would be lifting something while holding it very far away from your body, such that your arms become sort of like a lever arm. And that multiplies the forces going across your lower back.
Amanda Wilde (Host): So what is proper lifting technique?
Dr Esteban Cuartas: So it would be the opposite of that. So trying to bend with your knees as people say, which means really keeping your back at its most favorable position, which is with the discs, horizontal to the ground, or to the forces. So you bend at the knees and you keep your back straight. you try to keep things close to your body. And you try not to lift heavy things like 50 pound rock or something like that and twist, because the grinding motion is sometimes not what discs are really built for. I would say that the last point is if something is very heavy, get help or use machines. So those are my simple suggestions and they sound really basic. But when you go back and talk with patients that got hurt sometimes that's when it really makes sense.
Amanda Wilde (Host): Yeah, because that accident though, especially when you mention twisting, while you're holding something heavy, they just take a second, you know, of not thinking about what you're doing with your body, for something severe to happen.
Dr Esteban Cuartas: Yes. For example, during the winter first, snowfall, first couple of snowfalls, around here in the Northeast, we'll see a lot of patients that were trying to do a good thing, which is shovel their driveways and so forth. But they end up, injuring their backs. Same thing in the summer at the beginning of the summer, a lot of folks are taking out and installing their air conditioning units and their windows, and that leads to another set of injuries. But prevention is key.
Amanda Wilde (Host): Yeah. So how can you keep that in mind? I think it's just the fact that we don't think about it. Oh, I'll just lift this thing and we don't think about it. Is there something to trigger us to say something to ourselves before we lift something heavy?
Dr Esteban Cuartas: Well, , I usually say, no BLT, no bending, lifting and twisting. So, that pretty much encompasses those basic rules. No BLT.
Amanda Wilde (Host): That's perfect. Dr. Esteban Cuartas. Thank you so much for the great information on how to deal with such a common and painful lower back problem.
Dr Esteban Cuartas: Thank you.
Amanda Wilde (Host): Really appreciate your time. Thank you for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. For more information, please visit Montefioreslc.org. That's Montefioreslc.org. Please remember to subscribe, rate and review this podcast and all other Montefiore St. Luke's Cornwall podcasts until next time. I'm Amanda Wilde. Be well.
Lumbar Disc Herniation
Amanda Wilde (Host): One of the most common causes of lower back pain is a herniated disc. So today we're talking about how to identify and treat lumbar disc herniation with orthopedic spine surgeon, Dr. Esteban, Cuartas. Welcome to Doc Talk presented by Montefiore St. Luke's Cornwall. I'm Amanda Wilde. Dr. Cuartas. Welcome to the podcast.
Dr Esteban Cuartas: Thank you.
Amanda Wilde (Host): Lower back pain is incredibly common. Isn't it?
Dr Esteban Cuartas: Absolutely. Lower back pain accounts for huge proportion of hospital and doctor office visits every year in the United States.
Amanda Wilde (Host): We've talked previously in another podcast about lumbar stenosis, another lower back problem. So how do you detect a herniated disc? Is it different symptoms?
Dr Esteban Cuartas: So within the larger group of patients with acute back pain, are patients that have damaged disc, because they do include, clinically, patients with annular tears, which are tears of the outside ring of the disc. And patients that have a more formal herniation in which the outside contour of the disc is bulging out or ruptured completely. So the way we diagnose these is with, the clinical, physical exam, as well as imaging, which would mostly be MRI.
Amanda Wilde (Host): So when someone comes in with an issue at their lower back, this might be something you'd suspect since it's so common. And we should mention that ruptured and bulging discs are the same. Are they not as lumber disc herniation?
Dr Esteban Cuartas: I try to use different words to describe the different situations. So to explain on the clinical side, the patients may present very similarly either with just very severe and disabling back pain. But they may actually have different, pictures once we look at the MRI. The other component of this is whether or not they have a lot of sciatica type pain, which is pain going down a leg. some patients can have just back pain and no sciatica, but have a very clear large disc herniation on the MRI. So, they sort of use the term for, disc herniation clinical syndrome, to describe the presentation, but then I try to refine it for further understanding for the patients once we're looking at the MRI pictures.
Amanda Wilde (Host): Once you've determined, there is a disc herniation, how do you treat that?
Dr Esteban Cuartas: There's a very broad range of things that we, can do. We can prescribe a little bit of rest from, certain activities. Say, if work is very physical. We can prescribe anti-inflammatories as well as muscle relaxants. And sometimes anti-inflammatory steroid medication, which are also, usually called, prednisone or cortisone. We can also prescribe physical therapy is, helpful in some cases. And, finally we can also, prescribe more invasive treatments, including injections, and sometimes surgery is required to help patients improve their pain.
Amanda Wilde (Host): So it sounds like with rest and proper treatment of your body, you may recover from a herniated disc over time. You may not have to go to surgery?
Dr Esteban Cuartas: Yes. I would say somewhere between 80 to 90% of patients that have a damaged disc or herniated disc, can recover without surgery.
Amanda Wilde (Host): Well, that's encouraging. What can we do to prevent getting a herniated disc or does this commonly, it's so common, does it just happen over time?
Dr Esteban Cuartas: Some of the factors that lead to discrimination include lifting with Poor technique. So either lifting things that are just too heavy for your body frame or lifting with poor technique, which would be the basic three things are lifting while leaning forward or lifting heavy things and twisting your body, as opposed to keeping your body rigid. And the last one would be lifting something while holding it very far away from your body, such that your arms become sort of like a lever arm. And that multiplies the forces going across your lower back.
Amanda Wilde (Host): So what is proper lifting technique?
Dr Esteban Cuartas: So it would be the opposite of that. So trying to bend with your knees as people say, which means really keeping your back at its most favorable position, which is with the discs, horizontal to the ground, or to the forces. So you bend at the knees and you keep your back straight. you try to keep things close to your body. And you try not to lift heavy things like 50 pound rock or something like that and twist, because the grinding motion is sometimes not what discs are really built for. I would say that the last point is if something is very heavy, get help or use machines. So those are my simple suggestions and they sound really basic. But when you go back and talk with patients that got hurt sometimes that's when it really makes sense.
Amanda Wilde (Host): Yeah, because that accident though, especially when you mention twisting, while you're holding something heavy, they just take a second, you know, of not thinking about what you're doing with your body, for something severe to happen.
Dr Esteban Cuartas: Yes. For example, during the winter first, snowfall, first couple of snowfalls, around here in the Northeast, we'll see a lot of patients that were trying to do a good thing, which is shovel their driveways and so forth. But they end up, injuring their backs. Same thing in the summer at the beginning of the summer, a lot of folks are taking out and installing their air conditioning units and their windows, and that leads to another set of injuries. But prevention is key.
Amanda Wilde (Host): Yeah. So how can you keep that in mind? I think it's just the fact that we don't think about it. Oh, I'll just lift this thing and we don't think about it. Is there something to trigger us to say something to ourselves before we lift something heavy?
Dr Esteban Cuartas: Well, , I usually say, no BLT, no bending, lifting and twisting. So, that pretty much encompasses those basic rules. No BLT.
Amanda Wilde (Host): That's perfect. Dr. Esteban Cuartas. Thank you so much for the great information on how to deal with such a common and painful lower back problem.
Dr Esteban Cuartas: Thank you.
Amanda Wilde (Host): Really appreciate your time. Thank you for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. For more information, please visit Montefioreslc.org. That's Montefioreslc.org. Please remember to subscribe, rate and review this podcast and all other Montefiore St. Luke's Cornwall podcasts until next time. I'm Amanda Wilde. Be well.