Transcription:
What is a Herniated Disc?

Melanie Cole (Host):  Between 60 and 80 percent of people will experience low back pain at some point in their lives. Sometimes called a “slipped” or “ruptured” disc, a herniated disc most often occurs in your lower back and it's one of the most common causes of low back pain. My guest today is Dr. Hamid Hassanzaddeh. He's a fellowship-trained spine surgeon whose specialties include minimally invasive spine surgery, complex spinal deformities and herniated discs at UVA Health System. Welcome to the show, Dr. Hassanzaddeh. Tell us, what is a herniated disc? People hear this term and they're not even sure what that means.

Dr. Hamid Hassanzaddeh (Guest):  Good morning. Thanks for having me. So, our discs are built up out of two portions:   an outer portion and inner portion. When we get older, that outer portion ages a little bit faster and what happens is, you get small tears into the outer portion and part of the inner porter can come into the canal and pinch our nerve and create back pain and leg pain and so on.

Melanie:  So, the spine and the discs--how are they designed and are they supposed to be moving around like that?

Dr. Hassanzaddeh:  Absolutely. So, there are cushions for our cord and the mobility of our spine. We're able to move our back and neck because of part of it is because of the joints and part of it is because of the discs. Discs take the pressure when we jump and when we sit and that's where you're more prone to injuries and more prone to herniation or rupture. And, that's one of the first things that would cause a back problem when we get older.

Melanie:  Let's talk about what causes it first and then we'll get into some symptoms.  What are some causes? How does somebody herniate a disc?

Dr. Hassanzaddeh:  One of the biggest causes is genetic. Like, everything else, our genes basically predispose us to better quality or lesser quality of discs. People that have a family history of disc herniation or disc problems tend to have more problems when they become older than those patients that do not have the family trait. Other activities like bending forward--you feel the pressure. People try to lift something. It's a very common scenario that's the most of us try to lift that heavy box or that sofa, and a sharp pain in the back is a very common scenario. What happens when we bend over is, there's the highest pressure on the disc and we add some weight onto that. It increases the pressure in the disc and creates tears and creates the herniation. So, activity and genetics and some of it could be overuse that could cause this disc disease.

Melanie:  Is a herniated disc the same as a bulging disc?

Dr. Hassanzaddeh:  Not quite. A herniated disc means where a portion of the disc came into the canal and pinched some part of the nerve. Basically, herniation means part of the disc literally tears out of the disc into the canal. A bulging disc could be absolutely normal. When we get older, we lose some of the fluid and some of the height of our discs and the disc doesn't look quite juicy. It's a little like a flat tire and that appearance of a flat tire called a “bulging disc” could be absolutely asymptomatic and all people have it without knowing it.

Melanie:  So, what are some symptoms that people experience? People have low back pain from a myriad of reasons such their mattress, or as you say, they just reach something wrong or lift something improperly. What are some symptoms that this is actually an issue?

Dr. Hassanzaddeh:  Back pain, per se, is a multi-factorial problem. It could be a structural, or some bony structure, it could be disc or muscle, or all combined to cause back pain. A disc herniation, is very typical, especially in the lumbar spine. Disc herniation could also get in the neck and thoracic spine but the lumbar disc herniation is the most common problem and that is the most common area that it occurs. The lumbar disc herniation--the typical story is that they did something and felt a sharp pain initially and then that pain migrates or radiates down to the lower extremities. That's a very common description of disc herniation symptoms.

Melanie:  So, if someone has that pain going down their leg and they say, "Oh, I've got sciatica," then what do you do for them? Give us some of your first lines of defense, Dr. Hassanzaddeh, with some non-surgical treatments; things that you can try at the beginning and then we'll see if it needs to have surgery.

Dr. Hassanzaddeh:  Absolutely. The majority of people who have a disc herniation will not need surgery. So, what happens with discs is our body has some healing potential. We absorb the herniated disc and that makes it better. Time usually plays the rule into that. Secondly, we could help with treatment which could include injections. A steroid injection will decrease the inflammation around the nerves and alleviate the pain significantly. We tend to go, after the injection and once the pain is better controlled, we tend to send the patient to physical therapy to increase their core muscles. That’s a very important component of the entire stability of the spine and will prevent further damage and further degeneration of the disc. So, usually, if someone comes to me with acute disc herniation, then my task is, then, before we get even advanced imaging, if they have don’t have a neurological deficit, we send them for an epidural steroid injection followed by physical therapy and wait to see how they do.  If the patient is resistant to non-operative management, which includes at least a minimum of six weeks of non-operative management and sometimes as much as three months, then a surgical indication were given. But, like I said, a majority of patients will do well without surgery.  

Melanie:  How often are you willing to give an epidural steroid injection? Some people want to come in for them every couple of months or every six months. How often can somebody get one of those before it's enough?

Dr. Hassanzaddeh:  So, in my practice I do not like to have more than three injections, for those, a third injection, per year. So, if three injections fail to improve the symptoms, then we have to change our management plan, our management strategy.

Melanie:  Now, let's talk about prevention. Is there a way to prevent herniated discs and general back problems? What do you tell people, Dr. Hassanzaddeh?

Dr. Hassanzaddeh:  So, a strong core muscle could prevent a lot of back issues, if the muscles are very strong. The core muscles include the abdominal muscles, the back muscles, the thigh muscles, the chest muscles--they're all part of the core muscles. A very strong core muscle can prevent disc herniation, disc degeneration, and all other types of cause of back pain. So, my biggest recommendation to prevent back pain and disc disease is to keep your core muscles strong and stay active.

Melanie:  So, doing regular bits of exercise and in just the last few minutes here, you mentioned at the beginning some movements that people do. So, learning proper lifting techniques, because in my practice, Dr. Hassanzaddeh, I’ve seen people lift a weight and then they turn to set it down somewhere and right then and there you can see the pain. What do you tell people about these proper lifting techniques so that they don't do that sort of thing?

Dr. Hassanzaddeh:  Absolutely. So, this exact scenario you discussed is very common. Lifting and turning around creates increased pressure in the shear force which is a bad combination that could cause a tear in the outer portion. So, usually, I try to tell my patients to not lift from a bending position. Try to go kneel and lift this heavy object. Twisting, usually with the bending position, is not a great exercise for the back and could create inflammation; it could create tears, and so on. I think, overall, if they work on their core muscles, stay active, and do some activity modification, which also includes prolonged sitting, by the way. When we sit down, this is the time when the pressure is the highest on the disc. So, avoiding prolonged sitting, changing positions, standing for a minutes and doing some general modifications will really prevent a lot of trouble for our back.

Melanie:  Why should patients come to UVA Spine Center for their care?

Dr. Hassanzaddeh:  So, we have a phenomenal team of a multi-disciplinary approach. We have a great team management system and great interventional system where we the patient could receive their injections. We have a broad spectrum of experts including the spine surgeon and neurologists and interventionists that could help the patient to get everything in one place and world-class.

Melanie:  Thank you so much for being with us today. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.