Why Choose Cedars-Sinai Marina del Rey Hospital for Disc Displacement Treatment?
The highly skilled and well trained neurosurgeons at Cedars-Sinai Marina del Rey Hospital evaluate patients with spinal disc displacement and provide an individualized treatment advice for each patient. They can choose from the various nonsurgical and surgical treatment options available. The treatment that works best for your symptoms and severity of disc displacement is considered.
Disc displacement is a condition in which the soft disc present between the vertebrae of your spine is forced out of place. The spinal disc is filled with a jelly-like material and provides a cushioning effect to the vertebrae and keeps them stacked to make up your backbone. With advancing age, these discs may rupture or degenerate losing their cushioning ability. The jelly-like substance may get displaced from a weakened portion of the disc leading to pressure and irritation of the nearby nerves of the spinal cord. This causes pain and numbness in the arm or leg. Disc displacement is common in the lumbar spine (lower back), and may also occur in the cervical spine (neck).
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Disc Displacement
Spinal surgeries are performed only when conservative treatment methods have been ineffective in relieving pain. Surgical treatment may be considered if a disc fragment dislodges into the spinal canal causing pressure on a nerve and resultant loss of function. Surgical treatment options for lumbar spine include microdiscectomy or laminectomy, which depend on the size and position of disc displacement. In cases of cervical disc displacement, procedures like ACDF (anterior cervical discectomy and fusion) are recommended.
All these surgical procedures will be performed under general anesthesia mostly on an outpatient basis (some cases would require an overnight stay at the hospital). You will be able to return to work within 2-6 weeks after the surgery.
Surgical approaches for the treatment of lumbar disc displacement include:
Lumbar discectomy: There are 2 options – microdiscectomy and endoscopic (or percutaneous) discectomy.
- Microdiscectomy: In this procedure, a small part of the disc in the lower back that is exerting pressure on the spinal nerve root is removed. The use of targeting techniques such as fluoroscopic guidance minimizes the length of the incision required to gain a direct view of the operating area. Magnification is used to have an improved visualization of the nerve sac and the disc. This allows minimal muscle dissection and reduced post-operative pain.
- Percutaneous and Endoscopic Discectomy: These are minimally invasive techniques of discectomy and involve the insertion of a thin tube or a series of tubes into the lower back. This creates a corridor, which allows the surgeon to gain access to the displaced disc with minimal tissue dissection. A guide wire will be placed in the disc or near the neuroforamen. Over the central guide wire, thin tubes are placed sequentially to push away the surrounding soft tissues and provide an operative corridor.
Surgical approaches for the treatment of cervical disc displacement include:
- Anterior cervical discectomy and spine fusion (ACDF): This method involves the removal of the cervical disc by making a tiny one-inch long incision in front of the neck. After disc removal, the disc space is fused. A metal plate may be placed for spinal stability and better fusion.
- Posterior cervical discectomy: This approach is considered for discs that are displaced laterally out into the neural foramen. This method is technically more difficult than an anterior approach due to a higher number of veins in this area resulting in excessive bleeding.
- Cervical artificial disc replacement: This method is similar to ACDF and involves the removal of the affected disc through a small incision made in front of the neck. Then, the disc space is filled with an artificial disc, which simulates the form and function of the original disc.
Surgical approaches for the treatment of thoracic disc displacement include:
Surgical treatment is considered for thoracic disc displacement when there is myelopathy, progressive lower extremity weakness, and pain that do not get relieved with conservative treatment. One of the below-mentioned techniques may be used.
- Open thoracotomy: This is an anterior approach that crosses the thoracic spine. It involves access to the spine through the chest cavity. This procedure may also be performed through minimally invasive video-assisted thoracic surgery, which makes use of several smaller incisions, small tubes, and a video monitor.
- Costotransversectomy: This uses a posterolateral approach, meaning that the spine is reached from behind and side. This necessitates removal of a rib and the transverse process of the spine in order to provide access to the disc space.
Drugs and Other Treatment Needed for Disc Displacement
Your doctor may suggest a short period of rest and pain relieving medicines as initial treatment for disc displacement. This may be followed by physical therapy. Most patients are able to recover with these treatments and get back to normal routine. A few cases may need other treatments such as steroid injections.
Epidural Steroid Injections »
Lifestyle Changes »
Physical Therapy »
Disc displacement is classified into three types as lumbar, cervical, and thoracic disc displacement, based on the affected portion of the spine.
Cervical disc displacement »
Thoracic disc displacement »
Lumbar Disc Displacement »
Symptoms of Disc Displacement
The most common symptom of disc displacement is pain that typically occurs only on one side of the body. The pain gradually increases in severity, and may even become worse on standing/sitting, at night, while sneezing, coughing or even laughing, when walking, and bending backwards.
Symptoms of slipped disc in the lower back include:
- Low back pain
- Sharp pain in one portion of your leg, hip, or buttocks
- Numbness in the back portion of the calf muscle or sole of your foot
- Weakness of certain muscles in the leg and foot
- Loss of bowel/bladder control: It is very rare, but if it occurs, it may indicate a serious problem called cauda equina syndrome. This requires immediate medical treatment
Symptoms of slipped disc in the neck include:
- Pain near or over the shoulder bone
- Radiating pain that moves from the upper arm down to the forearm and the fingertips.
- Numbness or tingling sensation in the shoulders, elbows, forearms, and fingers.
Diagnosis of Disc Displacement
Your doctor will perform a careful physical examination and take a detailed medical history before ordering diagnostic tests. The physical examination involves evaluation of neck, shoulder, arms, lower back, legs, and feet depending on your symptoms. The doctor will check for numbness, muscle reflexes (slow or missing), muscle strength, and will examine your posture. You may be asked to sit, stand, and walk on toes and then on heels. You may also be asked to bend forward, backwards, and sideways, raise the shoulders, elbow, and hands to check for strength while performing these activities.
If you feel leg pain while sitting down on an examination table or while lifting your leg upwards, it is an indication of disc displacement in the lumbar spine.
- Spine X-ray: This is advised to preclude other causes of back or neck pain. This alone is not sufficient to confirm the diagnosis of disc displacement.
- Spine MRI scan or CT scan: This reveals the exact location where the disc is impinging on the spinal canal.
- Electromyography (EMG): This test is advised to locate the exact nerve root affected.
- Myelogram: This is done to find out the size and location of disc displacement
- Nerve conduction velocity test
Risk Factors for Disc Displacement
In most instances, a displaced disc is attributed to the natural aging process of the spine. As one grows older, the water content of the discs gets reduced because of which the discs turn weak. This aging process is termed, 'disc degeneration'.
In addition to the normal wear and tear that occurs with advanced age, other factors that increase the chances of having a displaced disc include:
- Gender: It has been found that males between the ages 30 and 50 are more likely to develop displaced disc than females.
- Weight: An overweight individual is at a greater risk of displaced disc problem because of the stress exerted on the discs of the lumbar spine.
- Sedentary lifestyle: Being active and regular exercise helps in avoiding several health problems including disc displacement.
- Incorrect lifting technique: Stressing your back muscles while lifting heavy objects can lead to disc displacement. Also, twisting motion while lifting may affect your back. Hence, lifting with the help of leg muscles protects your spine.
- Performing repetitive work that strains your spine: Certain jobs require more physical strain such as constant lifting, pulling, bending or twisting activities. People involved in such activities should follow safe lifting techniques to prevent disc displacement.
- Frequent and continuous driving: Driving very often for continuous hours requires staying in the same position for a long time and the vibration of the car engine can exert pressure on the spinal discs.
- Smoking: Smoking accelerates degeneration of the disc by reducing its supply of oxygen.
Causes of Disc Displacement
The disc may move out of its place as a result of injury or strain. Slipped discs most commonly occur in middle-aged men or older men, generally following a strenuous activity. Other causes may include congenital conditions that alter the size of the lumbar spinal canal.
You will be advised to try alternative treatment before considering the surgical means of treatment. These include:
- Acupuncture: This is an ancient Chinese treatment method that involves the insertion of very fine needles into specific points in your body. Depending on your problem, the practitioner will decide to insert multiple needles, which remain in your body for at least 20-40 minutes. This method causes the release of endorphins (natural pain relievers) into your blood.
- Acupressure: It is similar to acupuncture in restoring the healthy flow of energy through the body by stimulating certain points. Acupressure uses only fingers, hands, and elbows to exert pressure rather than needles. People of any age can undergo it except for pregnant women and individuals with high blood pressure.
- Chiropractic care: Chiropractic care has been beneficial in treating cervical spine problems. The two chiropractic manipulation approaches are cervical spinal manipulation and cervical spinal mobilization.
- Massage therapy: Massage, when done regularly in a proper way may provide relief from chronic low back pain. It involves gentle stroking, kneading or manipulation of your back tissues and muscles. This increases blood flow and delivers higher levels of oxygen to the muscles. While not a proven treatment for slipped discs, it is usually safe and does not cause any adverse effects. Massage therapy is not suitable for people with conditions such as osteoporosis, open wounds, skin infections, deep vein thrombosis, and arthritis.
Use of proper lifting techniques and maintaining proper weight can help avoid back injury. Here are some preventive measures that can help avoid disc displacement:
- Exercise: Performing muscle strengthening exercises to strengthen the trunk muscles helps both in stabilization and support of the spine.
- Maintain a healthy weight: Being overweight exerts excess pressure on the spine and discs, and makes them more susceptible to being displaced.
- Maintain good posture: Good posture helps reduce the pressure on your spine and discs. While sitting for a prolonged time, keep your back straight and aligned. Use proper lifting technique while lifting heavy objects - make your legs do most of the work - not your back.
- Using support braces: A back support brace may be recommended to people involved in constant lifting of heavy objects at their workplace. This helps support the spine and prevent injuries. Excessive use of these braces may weaken the muscles of your spine and worsen the problem.
Are you suffering from low-back pain? For any questions, information or guidance related to disc displacement, consult our specialty-trained, skilled neurosurgeons at Cedars-Sinai Marina del Rey Hospital.