What is a herniated disc?
Explained simply: between vertebrae are intervertebral discs, and in the center of the intervertebral discs there’s the gelatinous nucleus pulposus; surrounding the nucleus pulposus is a fibrous ring that contains an abundance of collagen. Intervertebral discs are made up of both of these types of tissue: nucleous pulposus and the fibrous ring. A herniated disc is when cracks appear in the fibrous ring and the nucleus pulposus is in a state of escaping outward.
There are roughly 2 types of herniated.
“Protrusions”: In this type, there are few cracks in the fibrous ring, and nucleous pulposus does not escape. However, nucleus pulposus does transfer backwards and place pressure on part of the nerve.
“Extrusions”: In this type, cracks appear in the fibrous ring due to intervertebral disc damage, and nucleus pulposus breaks through the fibrous ring and places pressure directly on the nerve.
What is the cause of herniated discs?
The main cause is deterioration of the intervertebral discs brought on by genetic factors and the burdens of aging and everyday life. The nucleus pulposus inside the intervertebral disc is essentially full of water, but cracks in the fibrous ring that come along with the burdens of aging and everyday life cause leakage of nucleus pulposus and loss of water content, which makes the disc become thin and collapse. In particular, lifting heavy things in daily life or playing intense sports causes damage to intervertebral discs. The intervertebral disc will appear dark on an X-ray or MRI, and its collapsed condition can be confirmed.
What is the cause of pain from herniated discs?
It was previously considered a mystery if there was no pain even when a disc was severely herniated or, vice versa, when serious pain came from a mildly herniated disc, but recently we’ve come to understand that, as a result of protruding nucleus pulposus causing inflammation, that inflammation spreads to nearby nerves and leads to the appearance of pain. Also, it has been established that the inflammation from protruding nucleus pulposus may disappear naturally within a fixed period (a few months). Metaphorically speaking, like an open fire, if it is given new fuel, it will burn furiously, but if some time passes, it will be the same as a fire that burns out. And cinders will remain after the fuel has burned up. With herniation, if it is naturally assimilated after the inflammation, it may remain like those cinders. The cinders-like remaining herniation can look severe in an image examination, but there are no symptoms because it is post-inflammation.
The pain from a herniated disc is not physical pressure on the nerves from escaped nucleus pulposus, the cause is inflammation due to fresh nucleus pulposus escaping.
This means, in other words, that people whose pain has continued for several months constantly have new nucleus pulposus continuing to leak out. On the other hand, it means that people whose pain has improved are experiencing a situation in which leakage of nucleus pulposus has stopped. This is extremely important. Surgery removes leaked nucleus pulposus and makes inflammation go away, but since it cannot close cracks in the fibrous ring, nucleus pulposus will continue to leak, which is the reason for the high recurrence rate (around 30%).
Surgery cannot treat the root cause of intervertebral disc problems.
Treatment of disc herniation
Conservative, surgical, and minimally invasive treatments:
Conservative treatment is often chosen as the first go-to treatment, using nerve root block injections and medication to relieve the pain and numbness.
However, if the pain or numbness are not relieved, surgery is then considered.
Surgery on a herniated disc depends on the severity of the condition, but in most cases, surgical removal of tthe damaged or protruding portion of the disc is the most common method, with endoscopic surgery such as PELD, MED being also common.
Minimally invasive treatments such as the PLDD method, which allows for treatment with a single needle without making an incision, and the Hernicore treatment have become the new established treatment options in recent years.
How is our treatment effective for herniated discs?
At our clinic, we perform repair and regeneration treatment for intervertebral discs that have aged and had cracks appear in the fibrous ring. We also perform PIDD, PODD, and PLDD treatment if the intervertebral disc has not aged and herniation is not protruding or extruding. However, when cracks have appeared in the intervertebral disc, it will eventually lose water content, and it is also thought that it will gradually narrow, so we recommend DST. Because DST(Discseel™) repairs tears in the fibrous ring that are the root cause of herniated discs, it is also effective for herniation that will not improve with surgery or that has recurred after surgery. Furthermore, if the nucleus pulposus continues to leak, the intervertebral disc will collapse, and the patient’s condition will ultimately be complicated by spinal stenosis. But preventing leakage of nucleus pulposus returns the intervertebral disc’s cushion function to its resilient state and inhibits the progress of spinal stenosis.
Repair and regeneration of the intervertebral disc is done with DST(Discseel™) treatment.
This is an illustration of an intervertebral disc that was repaired and regenerated with DST(Discseel™) treatment.
DST(Discseel™) is a treatment that can return collapsed intervertebral discs or discs that have lost water content and aged to their original, youthful state by repairing damage and aging and by regenerating the disc.
However, in cases of overly severe herniation, we may suggest first having surgery for the purpose of suppressing inflammation and then, after surgery, undergoing our clinic’s intervertebral disc treatment to prevent recurrence and maintain disc function.
Also, even in cases when an X-ray or MRI leads us to believe an intervertebral disc is normal, cracks may actually have appeared in the disc, and the nucleus pulposus may be leaking out little by little, factoring into pain. This may be diagnosed as low back pain of indeterminate cause. Our clinic’s DST(Discseel™) treatment uses contrast radiography to check whether there are cracks, so we perform reliable testing and diagnosis for patients whose low back pain has been assumed to have an indeterminate cause, and we can treat those patients.
How to Prevent Herniated Discs
Herniated discs are the most common condition among the young, a generation which is also working.
Those who have to sit for long periods of time need to be especially cautious about their daily sitting posture and the way they move their bodies.
Occasionally getting up and stretching, or walking can help reduce the toll on your lower back.
It is also important to do one’s best to prevent back pain and recurrence by stretching your body.
If you are often carrying heavy objects, bending your knees and lifting the load instead of lifting it from the waist will reduce the burden on your back.
Q&A on herniated discs
How do you diagnose whether a disc is herniated or not?
After reviewing your current symptoms, their progression so far, and the results of your physical examination, we perform a detailed examination using MRI scans and X-rays to make a comprehensive diagnosis.
An MRI is an effective way of visually confirming the presence of a hernia. An MRI examination will show the position, size, shape, and degree of nerve compression of the disc herniation, and will determine whether if it is better to leave it to heal naturally, or if treatment is necessary, which will be the most appropriate to choose.
Depending on the efficiency of the MRI and the way it was taken, an MRI scan may fail to show a small hernia.
Even if herniation is apparent, the numbness or pain may have a different cause.
Or you may have been told that it was not a herniated disc when there was in fact a small herniation, or conversely you were mistakenly told that it was a herniated disc.
It is entirely possible that you actually suffer from a different condition altogether, so please consider consulting a doctor first.
Does a quick cure for a herniated disc exist?
All in all, it is important to try to live a life as free of symptoms as possible.
Presently, there exists no medication, exercise, or rehabilitation that can reduce the size of a herniated disc.
Neither can physical therapy, massages, or electrotherapy offer a cure to reduce the size of a herniated disc.
If you feel pain or numbness depending on your posture or the way you move, it may be because your nerves are irritated.
All in all, it is important to try to live a life as free of symptoms as possible.
How soon will I be able to walk after surgery on a herniated disc?
Depending on the procedure, a surgical removal like PELD or MED will usually require a hospital stay of 2 or 3 days. After that, you are free to go home.
The PLDD and DST methods, which are also performed at our hospital, are a same day treatment, so you can go home within an hour after surgery.
Is a herniated disc a dangerous condition?
Many people can have severe symptoms that may strong enough to prevent some from sitting or walking.
What happens if a herniated disc is left untreated?
A herniated disc is a condition in which symptoms may sometimes disappear and the disc may heal on its own.
A herniated disc cannot repair or regenerate itself, but the protruding part of the disc can shrink or disappear.
We try to minimize the toll of treatment by monitoring changes in symptoms before considering surgical intervention.
Will a hernia recur once removed?
At first, the surgical removal may provide some pain relief, but the nucleus pulposus, which is in the disc, may then also leak out of the excision and cause it to recur.
The DST is the only method that can reduce the risk of recurrence by sealing the leaking disc.
Can I be re-operated after having already had a surgery?
Yes, it is possible.
We use a needle-based treatment, which means that you can be treated even after a previous surgical procedure.
You will be examined and according to the established diagnosis, the most suitable treatment course will be determined.
If I have been diagnosed with a herniated disc, should I avoid exercising?
Moderate exercise is necessary unless pain makes it impossible.
Neglecting to exercise can cause your body muscles to weaken and make the pain more severe.
Learning the right way to exercise can help alleviate your symptoms.
Our clinic is working in association with a rehabilitation center specialized in back pain treatment to help you cure your back pain at root level.
What precautions should I take after a herniated disc surgery?
After treatment for a herniated disc at our clinic, you can go home on the same day, but we ask that you wear a corset on your lower back and stay in a resting position.
We also recommend that you refrain from strenuous exercise for a month or so, and that you walk and stretch moderately.
How many times will I need to go to the hospital before surgery for a herniated disc?
In the case of treatment at our clinic, you can receive treatment on the same day after diagnosis.
In some cases, you may prefer to come only for diagnosis, and choose to have treatment at a later date of your choosing.
Can I fly after my herniated disc surgery?
Depending on your symptoms, you may be able to board a plane.
In the unlikely event that you suffer from post-operative pain, your doctor may decide against io please contact our clinic if you feel anything unusual.
5 Types of Outpatient Treatment for Low Back Pain
The DST Method (Discseel™)
An intervertebral disc treatment that began in the United States in the 2010s. Can be suitable for a wide range of conditions, including problems in patients after surgery. It is the only （※2）treatment that can repair and regenerate intervertebral discs.Click here for details.
※2 According to research by Operation Japan (Ltd.)
The PIDD Method (Implant)
An implant intervertebral disc treatment that has been conducted since the 2000s. As with PLDD, results without injury to intervertebral discs can be anticipated. This treatment is suitable for herniated discs only.Click here for details.
Hybrid Laser Treatment
A treatment that combines the benefits of PLDD and PODD. This treatment is suitable for herniated discs only.Click here for details.
The PODD Method (Ozone)
An ozone intervertebral disc treatment that has been conducted mainly in Europe since the 1990s. It can be suitable for a wide range of conditions.Click here for details.
The PLDD Method (Laser)
An outpatient, laser intervertebral disc treatment that has been well known worldwide since the 1980s. This treatment is suitable for herniated discs only.Click here for details.