LUMBAR HERNIATED DISC SPECIALISTS IN NEW JERSEY

HOW DO DISCS HERNIATE?

A herniation occurs when the outer band of the disc breaks or cracks and the gel-like substance from the inside of the disc leaks out, placing pressure on the spinal canal or nerve roots. In addition, the nucleus releases chemicals that can irritate the surrounding nerves causing inflammation and pain.

Most lumbar disc herniations our New Jersey back pain doctors see occur as a result of sudden stress, such as from an accident. Sometimes they occur gradually, over weeks or even months. The risk factors that can contribute to the chances of a disc herniation, include:

• Aging. As we get older, discs gradually dry out, losing their strength and resiliency.
• Lifestyle choices. Lack of regular exercise, not eating a well-balanced diet, being over-weight, and tobacco use substantially contribute to poor disc health.
• Poor posture, incorrect and/or repetitive lifting or twisting can place additional stress on the lumbar spine.

SYMPTOMS

Symptoms of a lumbar disc herniation may include the following:

• Dull or sharp pain in the lower back, intensified by movements or activities such as bending, coughing, or sneezing.
• Muscle spasms or cramping.
• Sciatica (pain, burning, tingling, and numbness that extends from the buttock into the leg or foot).
• Leg weakness or loss of leg function.

DIAGNOSIS

Good treatment is always based on an accurate diagnosis. Our comprehensive diagnostic process includes:

• Medical history. We will talk to you about your symptoms, how severe they are, and what treatments you have already tried.
• Physical examination. You will be carefully examined by one of our spine specialists for limitations of movement, problems with balance, and pain. During this exam, we will also look for loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of spinal cord damage.
• Diagnostic tests. Generally, we start with plain x-ray films, which allow us to rule out other problems such as infections. CT scans and MRIs are often used to give us three-dimensional views of the lumbar spine and can help detect herniated discs.

TREATMENT FOR LUMBAR DISC HERNIATION

The good news is that most cases of lumbar disc herniation our New Jersey back doctors deal with do not require surgery! Long-standing evidence suggests that pain associated with a herniated disc often diminishes without surgical treatment within 4-6 months. Unfortunately, it is not possible to predict which cases will have natural resolution, and which will not. Thus, patients are usually prescribed non-surgical treatments initially to help relieve symptoms.

Discover Our New Cutting-Edge, Minimally invasive spine surgery with Barricaid

Barricaid is a small implant, slightly larger than a pencil eraser that is designed to plug the larger holes in the disc wall. It is made up of a titanium bone anchor which secures the polymer plug into the disc space to repair and reconstruct disc wall.

Patients who undergo the Barricaid procedure following discectomy often can return to work and activities quicker than those who undergo discectomy alone. At IGEA, patients are enrolled in a recovery protocol that focuses on resistance training and core conditioning to build abdominal and lumbar core strength. Barricaid enables patients to restore confidence in their body following discectomy surgery by reducing the risk of reherniation, allowing them to quickly return to the activities they love most.

Is Barricaid safe?

The Barricaid implant was rigorously tested in multiple clinical studies and approved for use by the U.S. Food and Drug Administration (FDA) through the PMA process which is the gold standard for measuring safety. Barricaid has been implanted in over 11,000 patients with follow-up durations as long as 10+ years.

Is Barricaid Effective?

Barricaid has been studied in 8 distinct study populations, including 2 Randomized Controlled Trials. The studies report that Barricaid provides an 81% reduction in reoperations for reherniations 1.
1 Some studies outside US indications. Min 1-year post-op. Minimum study size of 20 Barricaid subjects.

Is there still a risk of reherniation and reoperation following a Barricaid surgery?

No device can provide a 100% guarantee of effectiveness. Although Barricaid greatly reduces the risk of reherniation and associated reoperation rates, the risk is not reduced to zero. Your surgeon will provide post-operative instructions to follow to ensure you receive the best possible outcomes.

Will Barricaid change my recovery time or post-surgery therapy?

Clinical studies showed that recovery outcomes were similar between discectomy surgeries with or without Barricaid. But because Barricaid provides protection against reherniation, patients are often able to return to work faster than traditional discectomy patients. In fact, a recent study has shown that 92% of Barricaid patients are back to work within 90 days 2.
2 2023 Nunley et al

NON-OPERATIVE TREATMENT

A combination of the following treatments will be used with most herniated disc patients:

• Pain medications such as anti-inflammatories to reduce swelling and pain, muscle relaxants to calm spasms, and occasionally narcotic painkillers to alleviate acute pain.
• Heat/cold therapy, especially during the first 24-48 hours.
• Physical therapy exercises such as gentle massage, stretching, and strengthening exercises to decrease pain and increase flexibility.
• An epidural injection of anti-inflammatory medication. This is for patients who have severe pain or significant leg pain.

SURGICAL TREATMENT

If after non-surgical treatment the patient still has intolerable pain, or if there is evidence of neurosurgical deficit (e.g. weakness in the calf muscles) then we may recommend surgery to treat the disc herniation.

To relieve nerve pressure and leg pain, surgery usually involves removing part or all of the damaged disc. This is called a discectomy. At our practice, this procedure can often be done utilizing minimally invasive techniques. Minimally invasive surgery uses smaller incisions and specialized technology such as microscopes and endoscopes (“mini-video cameras”). Microdiscectomy and minimally invasive techniques often result in quicker patient recovery times compared to traditional techniques, as they reduce trauma to muscles and minimize blood-loss during surgery.

Spine fusion is rarely necessary when a disc is herniated for the first time. If necessary, the space left by the removed disc may be filled with a bone graft – a small piece of bone usually taken from the patient’s hip. The bone graft or a bone substitute is used to join or fuse the vertebrae together. In some cases, specially designed instrumentation (such as rods or screws) may be used to help promote fusion and to add stability to the spine.

In addition to a discectomy, a portion of the bone covering the nerve may also need to be removed. This procedure is called a laminectomy.

RECOVERY

At our spine center in New Jersey, most patients can begin getting out of bed on the same day surgery is performed. Activity is gradually increased and patients are typically able to go home within 24 hours after their procedure, depending on the extent of the surgery. There will probably be some pain after the procedure. However, we have pain medications available that will keep you comfortable.

At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a week or two after surgery. We will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. Our New Jersey spine center will also discuss with you a timeframe for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as work, sports and yard work.