The Treatment of a Herniated Disc

Herniated Disc Treatment

Lumbar decompression surgery is an option if nonsurgical treatment (generally 4 to 6 weeks) fails to relieve pain from a herniated disc. A microdiscectomy (or microdecompression), a type lumbar decompression procedure, is often used to treat nerve pressure from a herniated disc.

To allow nerve pressure relief or better access to the nerve root, a portion of the facet joint can be removed. A minimally-invasive microdiscectomy procedure is used to remove the herniated disc below the nerve root. The nerve root is given more space to relieve pressure and allow the nerve root to heal.

Microdiscectomy is a highly effective procedure for relieving leg pain (sciatica), caused by a herniated disc. While the nerve root can take several weeks to heal completely, patients often feel relief from their leg pain immediately and have very little discomfort after the procedure.

What is microdiscectomy?

Microdiscectomy is a procedure that relieves pain from a herniated disc. The surgeon will remove small pieces of bone, disc and ligament to free the nerve.

Microdiscectomy can be described as minimally invasive spine surgery. It requires only a small incision. The surgeon uses a microscope and surgical glasses called loupes to magnify the area where the injury occurred. To work within the narrow space of the spine, the surgeon uses smaller tools and instruments.

 Microdiscectomy can be described as a type or spinal decompression surgery. The term microdecompression, which refers to the surgical removal of any bone or ligament that has compressed a nerve, may also be used. The term “microdiscectomy”, however, refers to the surgical removal of the herniated disc tissue fragment that is causing the patient’s symptoms.

Most patients can recover from a herniated disc without surgery. However, microdiscectomy should only be performed after conservative treatment has been completed. This includes physical therapy and cortisone injections. Motor weakness in some cases may warrant this surgery earlier. Cauda Equina Syndrome patients require immediate surgical intervention. 

It is a condition where pressure on the nerves of the lower spine causes problems with bladder and bowel function. However, it affects less than 1% of patients.

Microdiscectomy Techniques

Midline microdiscectomy is a procedure in which the surgeon makes an incision at the back that’s one to two inches in length. This allows the surgeon to lift the surrounding muscles and use instruments to separate the layers of tissue.

Tubular microdiscectomy is when the surgeon inserts small tubes or dilaters through a small incision. This creates a passage through the muscle for the surgeon to operate. Endoscopic microdiscectomy, also called microendoscopic discectomy, is a procedure that involves a smaller incision and uses specialized instruments and cameras. This method causes less tissue damage.

What are the advantages of microdiscectomy?

No matter which microdiscectomy technique is used, the goal of surgery is to remove the disc fragment as well as any bone or ligament that might be compressing the nerve roots. The surgeon makes a small opening in the vertebra to remove the ligamentum flavum and other underlying tissue. This exposes the dura (the covering around the spine) as well as the nerve root. To complete nerve decompression, the surgeon will also remove the herniated disc.

To ensure that the correct surgical site is located, imaging techniques such as X-rays are used, sometimes before and sometimes during surgery.

Although herniated discs can occur at any level of the spine or in almost every part of it, lumbar microdiscectomy is the most common location for this procedure. It involves removing the lower back.

What is the average time for a microdiscectomy?

Microdiscectomy takes on average between 30 and 60 minutes. The average time for microdiscectomy surgery is about two hours due to the fact that patients must be monitored and given general anesthesia.

Nearly all people who undergo microdiscectomy can return home within 24 hours. Patients are usually discharged from the hospital with a small amount of pain medication, including acetaminophen and small amounts of opioid medication. They also receive instructions on post-surgery care and how to adjust these medications. Patients who present with symptoms such as muscle weakness, altered bladder function or severe leg pain should be referred to a doctor immediately.

What complications could microdiscectomy cause?

Multiple safety precautions are taken during surgery to prevent bleeding, infection, and injury to surrounding tissues. Rarely, there may be a tear in dura (the tissue that surrounds the spinal nerves). This can be repaired by the surgeon using a suture or a collagen patch.

How long is the expected recovery time for microdiscectomy?

Many patients feel able to return to work after a two week period of rest. A microdiscectomy recovery usually requires six weeks of modified activity. This includes physical therapy that begins at week two or three.

Physical therapists help patients strengthen their core muscles and loosen stiff joint. They also create a home exercise program that helps protect the spine. Patients are advised to gradually return to their old routines, especially if they have to do physical labor. People with more sedentary jobs need to pay attention to their posture.

Patients who want to drive again after surgery should wait until they feel pain-free and have stopped taking any medication that can cause drowsiness. Before returning to regular roads, it is a good idea to practice driving in a safe place, such as a parking lot, with another driver.

Is microdiscectomy painful?

Most patients tolerate a low dose of non-opioid pain medication after surgery and a medication that relaxes their muscles. Although there may be some discomfort from the incision, most patients feel immediate relief from the herniated disc pain.

Patients who have suffered nerve compression or associated symptoms for a prolonged period of time may experience pain relief that takes longer. Leg pain that has been the main symptom is usually relegated to the lower leg. Patients may also experience mild numbness, tingling, or muscle cramping after surgery. These symptoms usually disappear with time.

Who is eligible to have a microdiscectomy?

Patients with herniated discs who are not responding to physical therapy and medication over time are eligible for a microdiscectomy. Although the majority of patients with this condition are between 30 and 50 years old, it can also occur in people older than that.

Children and young adults are less likely to have herniated discs than those in their 20s. However, they are more often able to heal themselves without the need for surgery. Adults in their 80s and 90s may benefit from microdiscectomy, but they should be aware that this can lead to more serious medical or surgical complications.

What is the success rate of microdiscectomy?

Microdiscectomy success rates are high, with many patients being very satisfied with the results. The success of microdiscectomy is dependent on the patient’s commitment to good spinal health after the procedure.

Noting that herniated discs can also cause nerve-related disability and pain, some people may also have other spine issues. If these conditions are causing their disability, you may need to have a laminectomy (a procedure that removes the bony roof covering the spinal canal).

What can I expect during recovery?

The results of herniated disc surgery are often more effective than other methods and they work faster. Within a few weeks of surgery, you should begin to notice a reduction in pain, weakness, or numbness.

You can recover faster with physical therapy or rehab. You can either go to rehab or do home exercises. Walking can help you to regain mobility in your spine.

Be careful in the first few weeks following your surgery to not:

  • Lift heavy objects
  • For long periods of sitting,
  • Too much bend or stretching

Your doctor will tell you when you are able to drive and return to work. In 2 to 4 weeks, you should be able to return to your desk job. You might need to wait 6-8 weeks if you are required to lift heavy items or operate large machines at work.

What are the risks? What is my outlook?

The majority of herniated disc surgeries are safe. Although risks are uncommon, they can include:

  • Infection
  • Nerves and blood vessels damaged
  • Probleme with the new disc
  • Leakage of spinal cord fluid
  • Bleeding

There is a chance that surgery will not improve your symptoms. Your pain may get better over time, but then return in the future.

Most people suffering from a herniated disc can get relief from their pain and other symptoms by surgery. However, it is not for everyone. The disc may herniate once more in about 5% of cases.

Surgery is not always the best option. Although it can provide faster relief than other treatments. Before you make a decision about a treatment, talk to your doctor about the risks and benefits.

The Successful Treatment of a Herniated Disc

Because each patient is different, treatment of a herniated disc can be complicated due to the unique nature of their pain and symptoms. One patient might experience pain or discomfort that is not the same for another. Patients can work with a variety of spine specialists to find the best treatment option for their pain. This can help them avoid surgery.

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Colorado Rehabilitation and Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Yasuyuki Nonaka, M.D. - Nonaka Lumbago Clinic

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Michael Wolff, M.D. - Southwest Spine & Sports