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How to Read the MRI for a Herniated Disc and 5 Treatment Options

Author:  
Dr. Deuk
An expert in all things spine, Dr. Deukmedjain is a board certified neurosurgeon who has performed thousands of minimally invasive surgeries and procedures including the revolutionary Deuk Laser Disc Repair and the Deuk Spinal Fusion. 
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Magnetic Resonance Imaging (otherwise known as MRI) is one of the most important inventions in modern medicine. With the aid of the MRI, surgeons can accurately evaluate and diagnose conditions that could otherwise be life-altering. MRIs are useful in many aspects of medicine, and especially so in investigating conditions of the spine. 

MRI for a Herniated Disc

MRI scans of herniated discs are a helpful test used to determine the exact location and condition of the problem. Patients who complain of experiencing symptoms related to herniated discs are often advised to get an MRI scan done first.

MRI scan is the best non-invasive test available to find herniated and bulging discs and annular tears. Because the spatial resolution of spinal anatomy can be defined to 0.5mm with an MRI scan, doctors can identify with over 95% accuracy the herniated discs in the spine. CT scans use harmful x-rays and have far less accuracy because of factors that reduce visibility of the soft tissue structural changes seen with a herniated disc. CT scans are best for looking at spinal alignment and bony issues as seen with spine fractures. MRI scans provide highly accurate representations of spinal discs and problems going on in and around the discs such as inflammation and degeneration. MRI is considered the gold standard in medicine for evaluating disc injuries.

What Is a Herniated Disc MRI and When You Might Need One

MRI scans are often used to diagnose and monitor herniated discs. One of the most common ways they are used is to identify the location of the herniated disc(s) in the spine and the degree of nerve compression. If the MRI results indicate a herniated disc, your doctor may recommend additional tests to evaluate the condition better. MRIs are useful for diagnosing herniated discs and bulging discs in the neck and back. 

What Your Doctor Might Do

After your doctor orders your MRI, the technician conducting your MRI will place you in a tube-like device. The device then rotates a magnet around a patient’s body, changing the level of excitation of hydrogen atoms within tissues in the patient’s body. Once the magnetic field is removed, the hydrogen atoms return to their usual resonance state and they release a small quantity of energy which the scanner may detect to produce the image known as the MRI scan. 

The generated MRI scan image depicts anatomy by distinguishing between tissues with a lot of water (such as cerebrospinal fluid or discs) and tissues with little water (such as skin, bone, cartilage, and nerve roots). Once this image is produced, your doctor will examine it for any anomalies to diagnose your condition. MRI scans are particularly sensitive for detecting disc injuries such as a lumbar disc herniation, bulging disc, annular tear which causes back discomfort or even a pinched nerve.

How to Read an MRI for a Herniated Disc

The interpretation of an MRI scan depends on several factors. The challenge with MRI scan results, similar to several other diagnostic tests, is that the "disorder" that appears on the MRI scan is not always the origin of backaches.

To accurately read a lumbar MRI scan for a herniated disc, patients must possess a basic understanding of the anatomical structure of the lumbar spine.There are 5 vertebrae components in the lower back and they are separated by two types of joints including facet and discs. In most cases, these discs are subjected to constant motion causing wear and tear. When the outer layer of the disc is ruptured, called an annular tear, its inner nucleus jelly squeezes out into the spinal canal and forms a hernia. This hernia will often show up as a contrasting spot in an MRI scan.

Fig. 1 MRI for herniated disc with or without contrast

As a general rule of thumb, MRI scan results are interpreted by the physiological symptoms exhibited and experienced by the patient. On its own, an herniated disc might not produce any symptoms in the patient, therefore there are many individuals who live with undiagnosed back conditions. However, when the herniated disc becomes bulged or protruded, it can begin to cause severe pains. An excellent video explaining how spinal disc herniations cause back pain can be found here

Back pain usually occurs when the herniated disc becomes inflamed along the posterior annular tear causing pain signals to travel via the sinu-vertebral nerve located along the margk-in of the annulus fibrosus. Because the nerve fibers along the annulus fibrosus posterior wall are somatic afferent (SA) pain fibers, they will project their pain signals to a region of the brain where highly localized pain is represented called the primary somatosensory cortex.

Fig. 2 MRI of a herniated disc in the lower back

Herniated Disc Causes 

In the spine, there are a total of 23 intervertebral discs. These discs are tissue joints that protect the spinal vertebral members from unexpected impact by having a soft gel-like interior and a firm outer wall (annulus fibrosus). The outer wall of the disc can sometimes develop a breach called an annular tear, allowing the jelly-like nucleus to squeeze through the annular tear. This is referred to as a herniated disc or bulging disc if the amount of nucleus extruded out of the annular tear is small.

A herniated disc can occur for a variety of causes. Trauma from injury or wear and tear are the most common. The cartilage that joins the discs in the spine to the corresponding vertebral member can become loose and lose elasticity as people get older. Sudden impact and trauma, such as accidents or falls, can also cause herniated discs.

Herniated Disc Symptoms

The most common way herniated discs cause symptoms is by irritation of nearby nerves. The interaction between the nucleus pulposus and the small blood vessels within the outer ½ of the annulus fibrosus cause a severe inflammatory response within the annular tear. When the inflammation occurs in the back of the disc where a certain type of pain nerve fiber is present, pain signals travel via somatic afferent (SA) sensory nerves to parts of the brain responsible for localizing the pain. The somatic afferent (SA) fibers end up synapsing on neurons within the post-central gyrus, an area of the brain known as the primary somatosensory cortex. This area of the brain gives pain signals from all over the body their location tag and associated qualities like “sharpness” and “stabbing”. It is only because the posterior annulus is innervated by SA pain fibers that we can easily identify disc pain location and quality from a herniated disc. Add link to animation

The most common symptom of a herniated disc is sharp pain localized directly over the painful inflamed disc(s). The inflammation from the disc herniation can spread to the dural covering around nerves and spinal cord causing irritation of nerves and even headaches. Headaches originating in the neck and moving upwards to the back of the skull are called “cervicogenic” headaches. When the disc is repaired properly with the Deuk Laser Disc Repair technique, the headaches go away permanently.

When inflammation from the herniated disc spreads to the nearby covering around nerve roots, painful sensations can travel down arms (cervical herniations) or legs (lumbar herniation or even around the ribs (thoracic herniations). One of the most prevalent areas to see signs and symptoms of a herniated disc is the nerve root dermatome. A loss of normal sensation in the arms, elbows, and shoulder is one example. Cervical radiculopathy is the medical word for this condition, which is characterized by radicular discomfort in this location and the appearance of a hot sensation radiating outwards from the source of pain. 

The nerve root myotome, which is the muscles in the arm or leg regulated by the nerve root, is likely to be affected by disc herniation. This frequently causes weakness in the muscles in this area, particularly the triceps, shoulders, legs, and upper arm in general. These anatomical parts may also be difficult to move for the patient. 

5 Best Treatment Options for a Herniated Disc 

Below we have highlighted seven of the best surgical treatments available for herniated discs;

1. Deuk Laser Disc Repair

The Deuk Laser Disc Repair treatment is a minimally invasive procedure. The surgeon utilizes an endoscope (a small tube with a light and camera attached) to reach the source of back discomfort without removing any supporting joints, bones, or ligaments by passing through a natural small opening in the spine called the neural-foramen. This surgery is a revolutionary, outpatient, all natural procedure that has proven to cure back pain or neck pain from herniated discs. This surgery is proven to be safe and effective using only FDA approved technology.

The surgeon uses a narrow endoscope to visualize the injured disc and then uses a precision laser to remove only the damaged disc tissue that is causing the pain. Because the injured tissue accounts for only 5 to 10% of the total disc tissue, the precision laser will not affect the surrounding bone and tissues, preserving the healthy disc.

Bulging discs, sciatica, spinal stenosis, pinched nerves, herniated discs, and other disorders that cause significant, chronic pain can all be treated successfully with Deuk Laser Disc Repair. There is no need for a hospital stay, narcotic painkillers, or opioids with this treatment. Patients can leave the clinic an hour after surgery with only a 1/4-inch incision and a bandaid. In over 1,000 procedures there have been no complications with every patient returning safely home.

2. Spinal Fusion Surgery / Spinal Arthrodesis 

The surgeon permanently unites or fuses two or more vertebrae during any spinal fusion operation. These vertebrae fuse together to form a single solid, long bone but natural movement is lost forever. This surgical procedure was developed to replicate the natural mending process of fractured bones.

Bone grafts can be obtained from the patient's hip during surgery, from a cadaver bone, or created ahead of time. Bone grafting along with metal implants are needed for fusion to occur usually. Recently over 100 patients receiving bone grafts for their fusions contracted Tuberculosis from the bone grafts. This unfortunate incident highlighted the serious complications that may occur from invasive types of spine surgery such as spinal fusion and artificial discs.

When a surgeon does spinal fusion, they completely remove the disc and implant a bone graft between the troublesome, painful vertebrae and then fuses the vertebrae to form a solid unit. This solid unit limits the motion of the painful vertebrae but there is a permanent loss of movement. Complications are common and can be severe, even life threatening.

There are several variants of Spinal Arthrodesis, including;

  1. Anterior Cervical Discectomy and Fusion (ACDF) 
  2. Posterior Cervical Decompression and Fusion (PCDF) 
  3. Transforaminal Lumbar Interbody Fusion (TLIF) 
  4. Extreme Lateral Interbody Fusion (XLIF) 
  5. Anterior Lumbar Interbody Fusion (ALIF) 

3. Discectomy Surgery

A discectomy procedure removes the external herniated portion of a damaged disc, relieving nerve root pressure. It does not treat back pain or neck pain, only leg pain or arm pain.  The surgeon performs this by entering the patient's back and making holes in the bones and ligaments of the spine to get to the herniation. The surgeon cuts through the tissues around the vertebra with various tools and removes bone, ligament and eventually only part of the herniated component of the disc. Surgeons are limited on how much of the herniation they can remove by how much they can see and since it is impossible to see all the herniation in a discectomy, they end up removing very little of the herniation. This is the main reason this procedure does not work well and it is not performed at Deuk Spine Institute. 

A discectomy means "cutting out the disc," and patients can have one or more discs removed in one treatment. Different vertebrae are referred to as "levels." The "open" approach is used to execute a discectomy. To see the spine directly, the surgeon makes a wider incision, which is more intrusive than the minimally invasive procedure.

In discectomy surgery, there is a very high chance of infection and nerve damage to the surrounding nerve roots due to the tools used for the incision and operation as well as the poor visibility. This is an older technique and does not use newer more advanced technology like the endoscope or microsurgery.

4. Microdiscectomy Surgery

A microdiscectomy procedure is very similar to a discectomy surgery. However, it uses a microscope and a 2-3 inch skin incision. A microdiscectomy is a surgical procedure that removes disc material that has spilled out and places pressure on nearby nerve roots. The surgeon creates a 2-3 inch incision on the patient's back above the ruptured disc area during the treatment. The surgeon next removes bone and ligaments from the spine to gain access to the hernia after cutting the muscle away from the spine. This method is typically used for those who have sciatica, a disorder caused by compression of the spinal nerves. This procedure doesn’t not treat back pain and frequently makes back pain worse. Many patients that have microdiscectomy get their symptoms back usually within a year or two and they require additional surgeries to correct the damage caused by the original microdiscectomy. 

When patients have leg weakness or numbness resulting from a herniated disc that puts pressure on the spinal nerve, this invasive method is often recommended by surgeons that do not have the ability to perform Deuk Laser Disc Repair. Because the surgeon must remove normal spine bone, ligaments and joints to reach the herniated disc, instability is common and many patients require a second or third surgery to correct damage from the first. The use of the microscope means this surgery is often performed at a hospital which has higher risk of causing infection. Because microdiscectomy requires the surgeon to damage the patient’s muscle, bones, spinal ligaments and spinal joints in an attempt to remove a small portion of the herniated disc and because complications are common and recovery from the surgery requires use of highly addictive opioid painkillers and the need for additional surgeries is likely, Deuk Spine Institute no longer performs this procedure.

5. Artificial Disc

Patients who have tried physical therapy and pain drugs yet still have unrelenting arm or leg pain are often candidates for artificial disc replacement. The surgeon removes the entire damaged disc and substitutes it with an engineered metal or plastic implant during an artificial disc surgery.

The damaged or degraded disc is removed and replaced with an artificial disc that operates similar to a natural disc. Surgeons access the spine by shifting delicate organs aside in the patient's abdomen or neck. Because of the serious problems that have been reported during the anterior (through the belly) surgery for lumbar disc problems, this is considered one of the most difficult and dangerous approaches to spinal surgery causing many surgeons and patients to avoid it. 

Patients should plan to stay in the hospital for 2-3 days after an artificial disc replacement before coming home in most cases. Usually within 24 hours of surgery, patients will be up and walking. Compared to fusion, the goal is to eliminate pain but preserve motion at the disc operated on.

Comparison of Surgery Options

How Long for a Herniated Disc to Heal Without Surgery? 

In many cases, herniated discs can heal naturally. These cases heal within days or at most 4 weeks. Approximately 90% of herniated disc cases are mild and don’t require surgery.  In such cases, modest treatments such as proper rest for a few days and temporary lifestyle changes for a few weeks only will be enough to alleviate herniated disc symptoms. Patients will often see symptoms disappearing entirely within weeks or even days.If pain or symptoms from a herniated or bulging disc last longer than 4 weeks the patient should have the Deuk Laser Disc Repair performed. Waiting longer will cause other muscles and joints in the body to deteriorate and begin to cause additional pain and dysfunction. Waiting on surgery beyond 1-2 months from symptom onset is ill-advised as it causes more damage to the patient and further robs people of the quality of their life.

A herniated disc squeezing a nerve root may occasionally be alleviated with a variety of physical exercises. These exercises range in difficulty and can be done by anyone, regardless of previous fitness experience or history. Low-impact workouts are especially recommended because they provide the least amount of pain and discomfort while working on specific muscle groups.

The Deuk Spine Institute is a premier concierge spine surgery clinic and outpatient surgical center specializing in minimally invasive surgical procedures and complete spine treatments for back and neck pain relief.

Click here for more information about Deuk Spine Institute and get started on your journey to a pain-free life.

Cure your back and neck pain once and for all.

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About Deuk Spine Institute
World leader in Laser Spine Surgery
With world-class physicians on staff, the newest and most advanced technology, and a patient experience pathway that is unrivaled in it’s efficiency and and pedagogy of care, Deuk Spine Institute has performed thousands of procedures and achieves a 95% success rate in elimination of pain.

 The services we offer are not offered anywhere else in the world, and the treatments are curative, not palliative.  On top of that, Dr. Deukmedjian is personally invested in the well-being of each and every patient, and has spared no expense to guarantee the best possible outcomes.
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