The intervertebral disc hernia (disc herniation), which occurs when the disc is degenerated, causing pain in the waist (back pain) and when a nerve (nerve root) is compressed, pain in the leg (sciatica).
Clinical diagnosis follows a specific protocol that includes:
- The medical history
- The physical examination
- The imaging exams
Patients exhibiting the above-mentioned symptoms should be asked by the Orthopedist about:
- The type of pain – The patient is asked to describe the characteristics of pain, including the location and activities that cause it.
- Concomitant health problems, such as osteoporosis
- Information on the patient’s work and daily living habits
- Family history
It is the most important step in the diagnosis and involves the observation of the patient’s movements, as well as palpation in combination with some special tests.
- Neurological Examination: In order determine if there is a particular neurological defect, the Orthopedist examines the lower limbs for signs of hypersensitivity, swelling or weakness. The patient is usually asked to walk on the toes and the heels, while finally controlling the reflexes of the lower limbs.
- Range of motion: The patient is asked to bend and extend his or her waist as far as the pain allows.
- Lasegue Test: With the patient in a supine position and the knees stretched, the Orthopedic bends the legs and triggers pain in the waist (lumbar spine) usually between 30 ° and 70 °.
- Complete neurovascular examination of both lower extremities
- Palpation of the lumbar area
- Observation of the patient’s gait
If none of the above-mentioned symptoms are presented and the level of pain is tolerated by the patient, further screening is often not required and a re-examination is planned.
Imaging is performed on the one hand to rule out some of the rarer causes of back pain, such as fractures, tumors and infections. On the other hand, it is also used to better describe and confirm the findings of the preceding clinical examinations.
- Radiographs: To rule out possible fractures (e.g. in patients with osteoporosis or a history of trauma) tumors or infections.
- Magnetic Resonance Imaging: It usually provides the most detailed information on whether or not a herniated disc is present, its location and size, as well as the compressive effects it causes. It is often performed for preoperative planning. It helps to rule out spinal stenosis.
- Computed tomography: Where magnetic resonance imaging is contraindicated.
- Myelogram or CT Myelography (CT): A contrast agent is used to visualize the spinal cord and spinal nerves. It may provide detailed information on the herniated disk but it is considered an invasive examination.
- Electromyogram: It can identify the affected nerve root.
In recent years, a new method has been used to inject a special gel into the intervertebral disc, with local anesthesia under radiological monitoring, in order to rebuild the disc and to relieve pain in the lower extremities (Discogel).
Small to medium-sized protrusions depicted in magnetic resonance imaging. Neck, back or waist pain due to disc herniation, sciatica or femoral pain, which restricts normal activity without improvement after conservative treatment
A discoplasty can be performed without requiring patient hospitalization; it is a minimally invasive procedure under local anesthesia.
There are practically no side effects and when the procedure is performed by a specialist doctor it can be completed within minutes and the patient is discharged from hospital within 2-3 hours. The main disadvantage is that the discomfort may not disappear when degeneration of the intervertebral space is advanced, or when pressure on the nerve tissue is due to another cause rather than to the disc. For this reason a very good selection of patients undergoing discoplasty should be made.