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Publications

Disc disease can be a pain in the neck, back, leg or arm

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It can feel like a pain shooting down your back into your buttock or leg. It can be an ache that starts in your neck and radiates into your shoulder, arm or hand. In younger people, the pain is often due to a herniated disc. In older individuals, progressive disc deterioration can lead to arthritis and spinal stenosis, a narrowing of the spinal column which can pinch the spinal cord and nerves. From ages 20 to 100, no one is immune from discogenic problems, those diseases that start in the discs.

What is a disc, anyway?
The right diagnosis
Conservative treatment first
Nearly 85% of people will have back and neck problems at some point

What is a disc, anyway?
Discs are the cushion-like structures sitting between each of our approximately 24 vertebrae, the bony structures that comprise our spinal column and are the main supporting structures for our bodies. The column is divided into the cervical spine (the neck), the thoracic spine (mid-back), and the lumbar spine (lower back). This bony structure of shock-absorbing vertebrae, discs, muscles and ligaments protects our precious spinal cord. The spinal cord is where electro-chemical signals travel to and from our brains to control movement, and bladder and bowel function.

The right diagnosis
Gerald Hayken, MD, chief of orthopaedics, Virtua Memorial Hospital, explains: "Depending where on the spinal column the disc is injured will determine the kind of pain a person will experience. Most disc abnormalities are located in the lumbar spine and create a combination of buttock pain, leg numbness, cramping and weakness. Before treating any patient, we first take a detailed medical history, perform a physical exam, and may do tests including x-ray and magnetic resonance imaging (MRI) studies."

If a disc is herniated or bulging, it may be pressing on a nerve, which is called nerve root compression. For example, if a disc is pressing on a nerve in the lumbar spine, a patient will probably experience pain commonly called sciatica.

Conservative treatment first
"Unless the patient is in excruciating, life-altering pain, we first start with the most conservative treatments. These include rest, anti-inflammatory medications, analgesics, oral steroids and physical therapy. If the patient is still in pain after a few weeks of conservative care, we might consider an epidural or a nerve-root bloc. Surgery is usually our last option, as it would be for most problems," explains Dr. Hayken.

Orin Atlas, MD, Virtua orthopaedic surgeon adds: "We always treat the patient, not just the radiographic finding - the finding on an imaging study. For example, about one-third of people in their 30s may have some degenerative changes in their disc space, but this does not necessarily mean they will have symptoms. Surgery is only warranted when more conservative treatment fails or the pain significantly disrupts someone's lifestyle."

Nearly 85% of people will have back and neck problems at some point
As people age, osteoporosis can cause a progressive loss of bone quality and quantity, which can lead to a vertebral compression fracture — a fracture of the bone at the front of the vertebrae. This serious problem causes chronic pain, loss of mobility and independence, and compromised respiratory function. Dr. Atlas explains a new, minimally invasive surgical technique to correct the problem: "Kyphoplasty (ki-fo-plasty) is a procedure where the surgeon needs to make only a minimal incision. He opens the fractured vertebrae with a surgical instrument, and fills the void created by the fracture with surgical cement. This technique stabilizes the fracture and provides dramatic pain relief, a 90% success rate in terms of pain resolution."