Though some people with a herniated disk feel no discomfort, others who have this condition may find that hard to believe. For them, the sharp, intense pain that radiates down their leg or arm makes it nearly impossible to work, exercise or do much of anything at all. 

Yale Medicine Orthopedics & Rehabilitation offers patients with herniated disks expert treatment, including an innovative surgical procedure called minimally invasive endoscopic laser-assisted spine surgery.

The vertebrae in the spine are separated by spinal disks made of 80 percent water and 20 percent soft tissue, with a viscous center. You can think of the disk as being like a jelly donut. A simple motion like leaning over sometimes causes the disc to twist and rupture, squeezing the jelly out of the donut in a way that presses on the sciatic nerve.

Up to half of people with herniated disks are unaware of the problem. Still, others suffer with severe sciatica (a sharp type of pain that shoots down the leg) that is caused by the disk pressing on the sciatic nerve. When the disk herniation is in the lumbar spine, the pain is mostly felt in the leg, with or without back pain.

Cervical (upper) spine disk herniation causes similar symptoms in the upper body. A person with this condition may have an acute episode of sciatica-like symptoms in the arms, with or without pain in the neck. Other symptoms may include numbness, weakness or tingling in the legs or arms. On rare occasions, loss of bowel and bladder control can occur.

Risk factors for a herniated disk include being overweight and doing repetitive bending and twisting. Age contributes to the problem, too, because wear and tear often cause disk degeneration, which raises the likelihood that a person will have a herniated disk. Also, the spinal disks of an older person contain less water than those in a younger person. Dryer disks are less flexible and therefore more prone to rupture.

Patient-reported symptoms and a physical exam typically lead a physician to suspect a herniated disk. A magnetic resonance imaging scan and X-ray are usually key to diagnosing the problem. Those imaging studies rule out other potential causes for the pain and can identify whether a patient has more than one herniated disk.

For up to 80 to 90 percent of patients with a herniated disk, the intense discomfort eventually subsides. Rest and over-the-counter pain relief medications are usually helpful. If those don’t work, other medications – including muscle relaxants or nerve pain medications or, less commonly, narcotic pain medications – may be prescribed. Steroid injections and physical therapy may be helpful too.

The remaining 10 to 20 percent of patients whose pain continues and interferes with their quality of life may benefit from surgery. An innovative new approach, called minimally invasive endoscopic laser-assisted spine surgery, is available from Yale Medicine Orthopedics & Rehabilitation.

Minimally invasive endoscopic laser-assisted spine surgery is often performed under local anesthesia. The procedure uses an endoscope (a narrow fiber-optic video camera) inserted into the bulging disk through a small incision in the back. The surgeon uses exceedingly small instruments to repair the damage, including (when necessary) lasers to remove bone spurs.

This approach has many advantages. For instance, the doctor can take the scope and turn it in directions that aren’t possible with a traditional open approach. It also allows the doctor to take care of people who have herniations in more than one location with just one incision.

This minimally invasive outpatient procedure can be done quickly, typically in less than an hour, and patients can often return to work within a week. Some patients may need other treatments down the road, but many find it is all they need.

Yale Medicine orthopaedic surgeons are have been pioneers in using the latest minimally invasive techniques. Yale Medicine Orthopedic Surgery was the first center in New England to offer minimally invasive endoscopic laser-assisted spine surgery.