The disks are the cushions, or shock absorbers, between the vertebrae (bones) of the spine. They are made of cartilage, and have two parts. The harder outer part (annulus) encloses a softer gel-like part (nucleus). You might imagine a jelly donut.
A herniated disk is where some of the jelly squirts out of a “crack” in the donut. The part that pushes out can put pressure on one or more of the nerves travelling in the spinal canal. The chemicals in the nucleus can also irritate the nerve. This combination of pressure and irritation can lead to a condition called radiculopathy, or sciatica. This can be any combination of pain, numbness, or weakness going down the leg.
Many people with leg pain from a herniated disk will get better with time. As many as 60% improve in the first six weeks, and as many as 80% by three months.
One treatment option is to “wait and see”, sometimes using physical therapy, massage, acupuncture, or chiropractic to help control symptoms. Sometimes oral steroids are used to decrease inflammation. Other medications may include a “nerve stabilizer” such as Neurontin (gabapentin), or a non-steroidal anti-inflammatory (NSAID).
Another option is what is called an epidural steroid injection. In this procedure, a Pain Management doctor uses an x-ray machine for guidance to inject a medication similar to Cortisone around the pinched nerve. The goal is to decrease inflammation around the nerve and improve leg symptoms.
Finally, the surgical option is to go in and remove the part of the disk that is pushed out and compressing the nerve. This is called a microdiskectomy, and involves a small incision on the low back so that we can enter the spinal canal, move the nerve out of the way, and take out the disk fragment. This has about a 90% chance of relieving leg pain, but it must be understood that it may not help back pain at all. It can usually stop the leg from getting weaker, but does not always result in the recovery of full strength. The effects on numbness are less predictable.