The Myth of the "Slipped Disk"



January 3, 2011

Top endoscopic spine surgeon Dr. Kaixuan Liu explains the newest remedy. At any given time, an estimated 15 percent of Americans suffer from low back pain, the vast majority of which can be traced to what doctors call a herniated or ruptured disc (and the rest of us know as a slipped disc or pinched nerve). It is a condition in which part of one of the discs in the spine bulges out and irritates the nerves nearby.

The pain from a herniated disc can stay in the back or radiate down one or both of the legs, a condition known as sciatica or radiculopathy. The vast majority of disc herniations occur in the lumbar region of the spine, which includes five discs in the area between the rib cage and the pelvis.

In most cases, a herniated disc will respond to conservative treatments—anti-inflammatories, physical therapy and exercise—plus stronger pain medicine, if necessary. But in cases where surgery is required, many patients now have a more appealing option than the old-fashioned back operations of the past, which involved general anesthesia, a hospital stay, plus lengthy (and often painful) rehabilitation.

“Now, according to Kaixuan Liu MD, PhD, a nationally distinguished leader in endoscopic spine surgery and chief surgeon at Atlantic Spinal Care in Edison, N.J., in cases of contained herniation, when the disc nucleus has not broken through the annulus, we can perform a minimally invasive procedure called an endoscopic laser discectomy, which uses a laser to repair the disc.”

The Myth of the “slipped disc” Unfortunately, despite its prevalence, this condition is widely misunderstood, meaning many patients don’t know much about what is causing their pain. The discs of the spine contain a spongy material, called the nucleus, that’s encased in a set of fibrous rings called the annulus. Everyday activities can create pressure on the discs that cause the nucleus to press against the annulus, but the body can generally cope with that pressure without any problems. “The discs are essentially shock absorbers,” Dr. Liu explains. “They cushion the bones of the spine from the impacts of regular activities as well as more serious challenges, such as running and jumping.”

Unfortunately, as we age, the annulus tends to degenerate and weaken, and the nucleus can begin to press against the annulus and cause it to bulge, or herniate, outward. Eventually, the nucleus may squeeze completely through the outer ring of the disc. Lumbar disc herniations are often caused by general wear and tear (people whose jobs require lots of sitting are especially vulnerable) that is followed by a sudden, traumatic injury such as the kind you experience when you lift something heavy while bending at the waist.

What’s more, the symptoms of herniated discs can vary enormously, Dr. Liu says. “A patient might feel very mild discomfort in cases where only the disc itself is affected. But if the disc material is pressing on nerve roots, you can experience severe and unrelenting pain in your back, buttocks and legs, plus sensory changes such as numbness, tingling, and muscular weakness that goes all the way to your toes.”

The New Remedy An endoscopic discectomy is one of the minimally invasive spine surgical techniques. If the disc is torn, the tear is easily located with endoscopic visualization. It has a wide application for spinal disc surgery. The indications include small disc tears, disc degerations, and all kinds of disc herniations. Often the pain is caused by a small disc tear, which can simply treated with endoscopic laser disectomy if patient failed all conservative treatments including epidural steroid injections. In this procedure, Dr. Liu explains, the surgeon delivers a few blasts of laser energy, which vaporizes the damaged disc material, kills the pain nerves within the disc and hardens the annulus to prevent any future leaking of disc nucleus. No scalpels necessary, he says.

Patients who would be considered candidates for the procedure have had chronic low back pain, which may or may not radiate into the legs, that has persisted for more than eight weeks (and has not responded to conservative treatments). In these patients, a diagnostic MRI, CT scan or other test will be used to confirm disc herniation, and a nerve diagnostic test (such as an EMG) will be used to show nerve root irritation.

The endoscopic discectomy uses a tiny camera, called an endoscope, which is passed through a small tube that has been inserted into the spine via an incision that’s less than in an inch long. The patient is lightly sedated and the area to be operated on is treated with a local anesthetic; the whole process typically takes less than two hours. It’s a speedy (and simple) procedure that means less pain, risk of infection or other complications, and a much shorter recovery time for the patient, as well. In fact, most people leave the hospital the same day, and are back to their regular activities in about six weeks.

“Studies have shown that endoscopic lumbar discectomies produce outcomes similar to standard discectomy surgeries—the vast majority of patients are pain-free after two years—with faster recovery times and less postoperative pain,” says Dr. Liu. “And in our practice, we’ve found that patients experience dramatic relief—and are amazed at how simple and painless the procedure is.”