A Herniated Disc Compressing Nerves: A Common Disease That Can Be Safely Treated

Risk factors of herniated disc compressing nerves include being overweight, improper back usage such as heavy lifting or prolonged sitting in inappropriate postures, forceful coughing or sneezing, and heavy smoking.
To identify a herniated disc, doctors typically begin diagnosing patients by taking medical history and physical examination. To confirm this condition, doctors will perform internal visualization using MRI.
Herniated disc treatment methods include medication treatments like pain relievers, anti-inflammatory drugs, or muscle relaxants, physiotherapy, and surgical approaches in case pain symptoms haven’t improved.
An endoscope is a medical device used to assist in spine and spinal disc herniation surgery (Endoscopic spine surgery) that increases precision and effectiveness of the treatment while reducing injury to surrounding tissues. The advantage of this minimally invasive herniated disc surgery is that surgeons can see the surgical site much more clearly during the operation without needing to make large incisions, thereby enhancing treatment effectiveness and reducing the likelihood of errors that might occur. The decision to perform herniated disc treatment with endoscopic spine surgery depends on the surgeon’s clinical judgment and each patient’s specific conditions.
To undergo endoscopic spine surgery at kdms Hospital, a specialized bone and joint hospital in Bangkok, Thailand, we have a specialized medical team with extensive experience treating patients with bone and joint problems including herniated disc treatment. They are also experts in using endoscopic technology in spinal disc herniation surgery, which is a technique requiring high precision. This surgical method not only helps reduce surgical wound size but also increases treatment accuracy, ensuring patients with a herniated disc receive treatment from the best specialists.

Herniated disc is a condition commonly found in patients experiencing back pain radiating down the leg (lumbar radiculopathy). Because the spine in this area bears significant weight and has considerably more movement than other spinal segments, it causes the lumbar disc to potentially tear and protrude, compressing nerves. The symptoms of a herniated disc are lower back pain extending to the hip area, along with pain radiating down the leg and a potential of numbness or weakness in the leg or foot. The radiating pain typically affects one leg side.

This disease is commonly found in patients aged between 20 and 50. Risk factors include heavy lifting, being overweight, smoking, and fast, violent body bending or twisting.

Understanding spinal discs: where are they in our body and what do they do?

The human spinal column consists of vertebrae and spinal discs (or intervertebral discs) positioned between each vertebra. The function of spinal discs is to help bear the body’s weight, acting as supports between spinal levels to enable flexible movement.

Despite being called “discs,” their structure mainly consists of water, collagen, and other components such as proteins. Seeing the illustration below, you can see the internal structure of an intervertebral disc comprises two main parts:

1. Nucleus pulposus

This is the central core of the disc, mainly composed of collagen and water up to 80%. It helps absorb and distribute forces of the body weight that are generated during body movement and transmitted to each spinal segment.

2. Annulus fibrosus

This is the surrounding tissue structure that wraps around the inner nucleus pulposus to prevent it from protruding. Its function is to provide stability and strength to the spinal joints, enabling them to withstand twisting, rotating, tilting, or bending forces.

Beyond structural characteristics, one special feature of spinal discs is that they are body components without direct blood supply to exchange nutrients, refill oxygen, and remove waste. Instead, they use pressure from bones pressing on the disc during body movement for nutrient exchange, resulting in poor self-repair processes. This is why disc herniation in our bodies may mark the beginning of spinal degeneration.

Causes of herniated disc compressing nerves

As previously explained, spinal discs directly support vertebrae and distribute forces caused by the weight-bearing function of the spine. Therefore, main risk factors contributing to a herniated disc are excessive bearing of the weight and violent, rapid movements that increase the likelihood of disc herniation as follows:

1. Excessive body weight

Because the heavier the body weight, the more burden the spine must bear accordingly.

2. Improper usage

Such poor postures like bending to lift heavy objects significantly increase pressure on the spinal discs, which may exceed their tolerance capacity and eventually lead to a herniated disc.

3. Prolonged sitting in inappropriate postures

Inappropriate sitting postures are commonly found in working-age groups. They pose the highest risk of disc herniation specifically in the lumbar area because that part of the spine fully bears the body weight during prolonged sitting.

4. Forceful coughing or sneezing

This is one cause of sudden pressure increases in spinal discs.

5. Heavy smoking

Smoking causes premature spinal disc degeneration and increases the likelihood of spinal disc herniation.

Disc herniation stages - 3 forms of herniated disc compressing nerves

1. Protusion

The inner nucleus protrudes outward while the surrounding tissue border (Annulus fibrosus) hasn’t torn yet.

2. Extrusion

The surrounding tissue border tears and the nucleus protrudes. However, the nucleus is still connected inside, not completely separated as an independent piece.

3. Sequestration

The surrounding tissue border tears, with the nucleus completely herniated as an independent piece from the inside. Initial pain symptoms of this stage are quite severe, occurring from two factors: the amount of nerve compression by a herniated disc and inflammation from disc herniation. Approximately 80% of patients undergoing treatment will gradually improve within 4-6 weeks, but the remaining portion may not improve due to significant nerve compression by a herniated disc, which may require a surgical solution for herniated disc treatment

Why does pain from a herniated disc typically radiate down only one leg?

According to the illustration, the circled part is the area that disc herniation normally occurs. It tends to bulge in a direction rather than herniating straight out the middle, and compress the nerve nearby on only one side. This leads to pain, numbness, or tingling radiating down just one leg.

Diagnosis of herniated disc compressing nerves

Doctors typically begin with medical history taking and physical examination, which alone can provide preliminary diagnosis of whether the patient has herniated disc compressing nerves.

To confirm this condition, doctors will perform internal visualization using Magnetic Resonance Imaging (MRI) to obtain 100% clear results. MRI clearly shows spinal disc and nerve structures, enabling determination of nerve compression location and its severity for herniated disc treatment planning.

Herniated disc treatment methods

1. Medication treatment

Medication treatment involves prescribing drugs according to the patient’s condition, such as pain relievers, anti-inflammatory drugs, muscle relaxants, or neurological pain medications.

Besides oral medications, another herniated disc treatment option is to inject pain-relieving and anti-inflammatory drugs at the nerve. For this method, doctors will have the patients undergo an MRI to locate where the herniated disc compresses the nerve, then inject the medication near that area using X-Ray guidance to identify the site.

2. Non-medication treatment

Physiotherapy: such as massage, ultrasound, laser therapy, and shock wave therapy to relax muscles and reduce pain. Additionally, there are exercises to strengthen and stretch the muscles as well.
Patient behavior modification: doctors analyze from medical history taking what improper behaviors the patients have and how they should be corrected.

3. Surgical Treatment

This will take place when the patients have undergone the above two treatment methods but pain symptoms haven’t improved. Surgical procedures for herniated disc compressing nerves include:

1. Open discectomy

This is the traditional surgical method from earlier times which involves opening an incision in the area with disc herniation, approximately 7-8 centimeters wide, to remove the herniated disc.

2. Microscopic discectomy

This surgical method requires a smaller incision of 2-3 cm. compared to open discectomy. The surgeons use external microscopy with 20-100 times magnification power to clearly visualize all nerves.

3. Endoscopic discectomy

Endoscopic discectomy is a surgical method utilizing an endoscope in the operation. The surgeon will create a small hole at the surgical site, then insert a pen-like device with a camera at its tip to visualize and perform a herniated disc surgery. This method will leave an unnoticeable incision, as tiny as 8 mm.

Besides a smaller wound size, the advantages of surgical method development for herniated disc treatment include the reduction of injury to healthy back muscles and spinal bones from surgery, less blood loss, less post-surgical pain, standing and walking ability on the first day after spinal disc herniation surgery, and faster post-surgical recovery. These enable the patients to quickly return to work and daily life with quality.

In summary, most of the risk factors for herniated disc compressing nerves arise from our improper behaviors. Therefore, the best prevention method from disc herniation is to start modifying the behaviors from today. That’s because even small changes of our habits can help reduce the burden on our spine.

Let’s get to know
what endoscopic spine surgery is!

An endoscope is a medical device used to assist in spine and spinal disc herniation surgery (Endoscopic spine surgery) that increases precision and effectiveness of the treatment while reducing injury to surrounding tissues. There are 2 surgical techniques involving an endoscope: uniportal endoscopy with a camera of a standard size between 8-12 mm. and biportal endoscopy with a 4-mm. camera and another separate port to insert surgery-assisting equipment.

The procedure of herniated disc surgery with endoscopic approach involves the surgeon making a small incision, then inserting the endoscope into the surgical site. The advantage of this minimally invasive spine surgery is that surgeons can see the surgical site much more clearly during the operation without needing to make large incisions, thereby enhancing treatment effectiveness and reducing the likelihood of errors that might occur. The decision to perform herniated disc treatment with endoscopic spine surgery depends on the physician’s clinical judgment and each patient’s specific conditions.

The perks of choosing endoscopic spine surgery for a herniated disc at kdms Hospital

Endoscopic spine surgery: advanced innovation for “small wound, less pain, quick recovery”

The specialized medical team at kdms Hospital, a specialized bone and joint hospital in Bangkok, Thailand, has extensive experience treating patients with bone and joint problems including herniated disc treatment. They are also experts in using endoscopic technology in spinal disc herniation surgery, which is a technique requiring high precision. This surgical method not only helps reduce surgical wound size but also increases treatment accuracy, ensuring patients with a herniated disc receive treatment from the best specialists.

Comprehensive and caring treatment: Besides treatment expertise, we focus on comprehensive and caring service at every step, from initial assessment, consultation, and surgery to post-operative care. Patients will be given close care from professional medical teams and nurses, making post-surgical rehabilitation highly effective.

After the treatment and endoscopic surgery, patients will return to a better quality of life. Quick recovery helps patients remove various limitations from doing their beloved activities compared to the traditional herniated disc treatment. Additionally, endoscopic surgery helps reduce long-term pain, enabling patients to live their lives happily and worry-free.

Q&A

After patients complete disc herniation surgery, the radiating leg pain will improve immediately, while leg numbness or weakness will be gradually better over time.

Two weeks after that, patients can begin returning to light activities such as sitting at work, driving, standing, and walking longer distances. However, they should still avoid heavy object lifting or excessive back bending. The patients will regain full functionality use, including normal work and exercise, within 6-8 weeks.

Studies show that the chances of disc herniation recurrence after surgery is 10-15%. However, we can reduce this risk by modifying improper behaviors and postures to reduce pressure on spinal discs, including back bending, heavy object lifting, smoking, and controlling weight.

In fact, every movement, whether sitting, walking, standing, or lying down, always puts our weight on the spine as it is the body’s central axis. This means if we perform daily routines in incorrect postures, the spine will work harder and potentially develop back pain.

Studies have shown how different daily postures burden the spine differently. Normally, the spine bears our full weight at 100% when standing straight. However, it bears more weight at 140-185% when sitting because full body weight is distributed to the waist area instead of the lower body parts. Sitting while lifting objects also multiplies the weight-bearing percentage to 275%. When the spine bears excessive weight, spinal discs are consequently affected as well.

Therefore, correct postures to help reduce spinal weight-bearing burden include trying to keep the back straight while standing, walking, and sitting as well as avoiding unnecessary heavy object lifting to reduce pressure on our spinal discs.

Consult symptoms before scheduling an appointment.