Posted March 02, 2023 by Paul Hartzfeld, M.D.
Listen to this episode of the Healthy Vitals Podcast.
Pain and symptoms from a spinal lumbar herniated disc can be easily mistaken by patients. Summa Health neurosurgeon Dr. Paul Hartzfeld answers some of the most commonly asked questions about treatment for lumbar herniated disc.
Scott Webb: Back pain is very common and something that many of us live with and deal with and often don't speak to our providers about. But we may have a lumbar herniated disc, and though that's a very common condition, it's also highly treatable. And joining me today to tell us more about it is Dr. Paul Hartzfield.
He's a neurosurgeon at Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Doctor. Thanks so much for your time today. I know that back problems, maybe I'm just speaking about myself, but just back issues in general, very common, also very treatable, and we're gonna learn about something specific today about that, what it is and how you treat it. So let's do that. Let's get started here with, a really baseline What is a lumbar herniated disc? What is that exactly, and how does it happen?
Dr. Paul Hartzfeld: I agree with you, one of the most common reasons people will see us in the office are for back pain, complaints, and it's probably thing that we deal with most often, and the thing that's most bothersome to patients when they see us. A herniated lumbar disc is a condition where one of the disks, which is the cushion between the bones of our or vertebral bodies in our low back. The cushion between those vertebral bodies is a disc and a herniated disc is a lump of disc or lump of disc material that has become extruded from its house or the disc space.
And become in contact with one of the nerve roots in the low back. And that results in having some back pain and some leg pain and or numbness. Commonly that leg pain is commonly called sciatica. So a lot of people come to see us saying they're having sciatica pain, and that is likely the result of. Disc pressing on a nerve in the low back.
Scott Webb: And is this generally wear and tear, is this just something that sort of happens over time, maybe sort of like osteoarthritis where it's just years of use and abuse or whatever? Or are you also seeing patients that have suffered some sort of acute injury?
Dr. Paul Hartzfeld: Most of the time, patients, when we ask them like, can you identify anything that caused this? They say no. They just woke up with it one day. In those cases, it's just the result of bad luck and wear and tear changes. Just being alive your whole life, working hard and using your back.
Scott Webb: Yeah. Yeah.
Dr. Paul Hartzfeld: Sometimes people will say, you know, I was shoveling snow the previous day, or we had just moved a bunch of boxes in my house, or whatever it may be, where I was doing a lot of bending or lifting or twisting, and I felt a pop in my back. And then the next day, my leg really started to hurt. So sometimes people can identify an inciting event, but most of the time they can't come up with anything specific. It just sort of happened.
Scott Webb: Yeah, just as you say, being a person. Live in a certain number of years, lift in boxes, shoveling snow, whatever it is. It just happens over time. You mentioned there a little bit, so some pain, numbness, but wondering if you can help listeners, when we think about the signs and symptoms of that herniated disc what are they most likely to experience?
Dr. Paul Hartzfeld: Most of the time the classic symptoms of herniated disc pressing on a nerve in the low back would be I woke up or I was lifting something and my back was really bothering me. And then a day or so later, my back felt better. But I had this lightning, I had this fire, I had this numbness that was traveling down my leg from my buttock into my thigh and then past my thigh and my calf, or in my shin and then into my foot in some way. Those are the classic symptoms of nerve pressing on or nerve being pressed on by a disc in the low back.
Scott Webb: And then for you, sort of as the expert in the room, when folks come in, you get patient history and you do a physical exam, how do you diagnose the condition?
Dr. Paul Hartzfeld: Some of it is clinical, just listening to the story, doing an exam. Do they have a weak foot like, a, a foot drop, or that doesn't even have to be a foot drop, but just pushing their foot down or pulling it up. Is it weaker than the opposite side that doesn't hurt? Those are all findings that are suspicious to us that there's gonna be a disc issue in the low back. The best way to diagnose that when we have that suspicion is to get an MRI of the low back that would clearly show the spinal canal, the discs, the nerves. And is there one impressing on a nerve in the low back?
Scott Webb: Yeah. And as one of the challenges, even for someone like yourself in terms of herniated disc versus other spine conditions is one of the challenges that the signs and symptoms well, it could be this, it could be that it's something in your back, but it might be a herniated disc or it might be something else. Is that one of the challenges is just differentiating between herniated discs and something else.
Dr. Paul Hartzfeld: Yes, That's why we like to hear a good story from the patient. And for instance, if they come in and say, my back bothers me, my leg doesn't bother me. They may have a problem in their back, but it may not be a disc pushing on a nerve. It could be a compression fracture or just a wear and tear fracture in a vertebral body that's causing them back pain, but not necessarily leg pain cuz that doesn't involve a disc pressing on a nerve. That's why eventually imaging really helps us out to make those appropriate diagnoses and differentiate one from another.
Scott Webb: Yeah, you'd be speculating in the office based on the patient history and what they're saying. But obviously in the end, imaging, MRIs, that's the, probably the gold standard in terms of diagnosis. It's been really, yeah, it's been really helpful and educational today. I think the thing on my mind and probably the minds of listeners, doctor, is what can you do to help? What are the treatment options?
Dr. Paul Hartzfeld: The treatment options can range from simple things that involve conservative nonsurgical options like physical therapy, chiropractic care, acupuncture, water therapy. All the way to more invasive options like cortisone shots or nerve root blocks. And finally, an operation that goes and unpinches the nerve by removing the disc material that's in contact with it. And depending on the clinical situation that helps us tell the patient what the best option for them is. For instance, if they're just having back and leg pain, they don't necessarily have weakness associated with that nerve being pinched.
A lot of the times we'll suggest, why don't we try to get you by without surgery? Let's do some physical therapy, chiropractic care, things of that nature, and if that solves the problem, excellent. If it doesn. Surgery is still an option or we could go to the next step, a little more invasive and have a nerve root block done and just get some cortisone, some steroid around the nerve root to see if we can make it calm down and feel better. And hopefully over time the disc will just regress back into the disc space and not put pressure on the nerve.
And finally, if that doesn't work or the conservative treatments don't work, then an operation where we go unpin the nerve by removing not the whole disc, but the piece of disc, which is already where it's not supposed to be would be the next step.
Scott Webb: Yeah, it's always good as patients to know there's options, you know, sort of lofi, minimally sort of invasive type options. But as you say, surgery is an option. If it's indicated, if you've tried everything else, it's an option, of course. And you and your partners, you had the expertise to do that. It's Summa Health. So Dr. Thanks so much. You stay.
Dr. Paul Hartzfeld: Yep. Thank you. Thanks for your time.
Scott Webb: And to make an appointment with a Summa Health neurosurgeon, call 330.576.3500 or visit summahealth.org/brain to learn more. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.
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