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Chapter 107 - Treatment of the herniated disc
- from Section 22 - Neurologic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 686-692
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Summary
Herniated discs usually occur in the cervical and lumbar spine. The thoracic spine is relatively non-mobile due to the attached rib cage and therefore is less commonly affected by disc herniations. Herniated discs typically occur in younger patients between ages 30 and 50 years and present primarily with appendicular pain (radicular pain of arm, leg) as well as axial pain (mechanical pain of neck, back). Cervical and thoracic discs may present with myelopathy due to spinal cord compression or radiculopathy from nerve root compression. Sometimes, a combination of myelopathic and radiculopathic symptoms is present. The majority of patients with a disc herniation obtain relief with conservative treatment. Herniated discs are the initial manifestations of the continuum of degenerative disc disease that is later manifested by dehydration of disc material, loss of disc space height, associated facet joint arthropathy, and the development of osteophytes.
Cervical level
Patients with cervical disc herniation typically present with arm and periscapular pain, and often with weakness, numbness, or paresthesias in a nerve root distribution. The majority of patients improve with non-surgical therapeutic options such as cervical collar immobilization rest, non-steroidal anti-inflammatory or corticosteroid medications, traction, and physical therapy. Sometimes epidural steroid injections or foraminal steroid injections are helpful. Typically, patients with troublesome symptoms that do not resolve with these non-surgical measures and that persist beyond 6 weeks–3 months are considered to be candidates for surgery. Patients with significant weakness or sensory loss may opt for surgery sooner.
99 - Treatment of herniated disk
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- By Maxwell Boakye, Emory University, School of Medicine, Atlanta, GA, Regis W. Haid, Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 688-692
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- Chapter
- Export citation
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Summary
Herniated disks usually occur in the cervical and lumbar spine. The thoracic spine is relatively non-mobile and thus rarely affected by disk herniations. Herniated disks typically occur in younger patients between ages 30 and 50 years and present primarily with appendicular pain (arm, leg) as opposed to axial pain (neck, back). Cervical and thoracic disks may present with myelopathy but more commonly with radiculopathy. Ninety percent of patients with disk herniation obtain relief with conservative treatment. Herniated disks are initial manifestations of the continuum of degenerative disk disease later manifested by development of osteophytes.
Cervical level
Patients with cervical disk herniation typically come to operation because of arm and periscapular pain, often with weakness, numbness, or paresthesias in a nerve root distribution. Since the majority of patients improve with non-surgical therapeutic options such as cervical collar, active rest, and physical therapy, patients should be considered for operation only if they have failed a reasonable trial of conservative therapy.
Central disk herniations are treated via an anterior approach. Foraminal disk herniations can be treated by either an anterior or posterior cervical approach. Anterior cervical diskectomy and fusion is the most common procedure performed for cervical disk herniations. After cervical diskectomy the disk space may be replaced with allograft or autograft. Studies have shown that using allograft leads to fusion in approximately 90% of patients. Addition of a cervical plating system increases the fusion rate to 96%.