Anatomy, Causes, and Treatments of Intervertebral Disc Herniation
By Alexander Germanis
When the ancient Greeks began studying the properties of light, the electromagnetic spectrum was thought to be made up only of visible light, in other words, the spectrum of colors that we can see. But as science progressed into the 19th century, infrared and then ultraviolet rays widened that spectrum. When Wilhelm Röntgen discovered X-rays in 1895, the spectrum expanded further, as did the world of medicine.
The spectrum of medical treatments has been widening ever since, especially when treating intervertebral disc herniation. Dr. Ramsin Benyamin, founder of the Millennium Pain Center in Bloomington, again compares intervertebral discs to soft-shelled eggs. When “the yolk (nucleus) pushes the white and the shell,” or the layers of annulus fibrosus that comprise the outer portion of the disc, part of the disc protrudes or essentially partially escapes the protective confines of the annulus fibrosus. “That’s called a disc herniation or protrusion.”
Disc herniations can then press against a nerve and cause sciatic pain. Last month, Dr. Benyamin outlined the initial approaches to treating that and other pains caused by disc herniations. “It used to be pure bed rest and taking some aspirin,” he reiterates. Once this was deemed to be insufficient, physical therapy was instituted.”
“In the early 1950s, epidural steroids were introduced and became one of the common ways of treating the symptoms of disc herniation — meaning the pain,” Dr. Benyamin adds. “And they are still used. Physical therapy is still used. They are the most common first step and, initially, they are effective, especially with leg pain. Other non-interventional ways of dealing with it are using anti-inflammatories and other stronger pain medications.”
But, as the doctor points out, these methods often only serve to treat a symptom. They can fail to treat the actual cause of the pain — the herniation itself.
To treat the source surgically, techniques were eventually developed to perform a discectomy, or removal of actual intervertebral disc material in order to eliminate the herniation.
Those “surgical techniques have also improved, making them less invasive and less intrusive to stabilizing elements of the spine, like the muscles,” Dr. Benyamin explains. “And this evolved as a result of poor long-term outcomes attributed to loss of muscle function, which were a direct result of more invasive surgical techniques.”
The only problem is, the doctor states, “regardless what surgical technique we use to approach the disc — whether you use a scope or you open it up and cut all the muscles to look at it — at the end, removal of herniated disc material leaves a disc that is damaged and will continue to lose its water content, leading to continued degeneration.” This can, as the doctor goes on to say, “eventually lead to either recurrent herniations or more invasive surgeries like spinal fusion.”
Fortunately, for this purpose, better methods were developed and are continuing to be developed. “It’s a wide spectrum” of methods meant to deal with one problem, Doctor Benyamin points out.
This means there are now ways to avoid even working endoscopically. Percutaneous methods, or techniques of approaching the affected disc through the skin, mean that portion of the outer shell of the disc does not have to be removed in order to rid the disc of the herniation.
Without seeking to expel the already long-lived techniques, the new percutaneous methods are just the next expansion — the next widening of the spectrum in the fight against intervertebral disc herniation.
For the concluding piece on disc herniation and the continuing evolution of treatments, please pick up next month’s copy of Healthy Cells Magazine to read “Anatomy, Causes, and Treatments of Intervertebral Disc Herniation, Part 4.” If you missed, the previous articles on intervertebral disc herniation, you may read it online www.HealthyCellsBN.com or contact Cheryl Eash, 309-664-2524 or email ceash7@gmail.com.
Millennium Pain Center, located at 1015 S. Mercer Ave. in Bloomington, provides the most advanced and comprehensive pain management for a wide variety of conditions. Drs. Benyamin and Vallejo have been selected among 70 of the Best Pain Physicians in America. For more information, you may contact them at 309-662-4321 or online at www.millenniumpaincenter.com.