A herniated disc occurs when one or more of the cushions that sit between the bones (vertebrae) of the spine slip out of place, or herniate, resulting in compression of a nerve. Typical symptoms include pain that radiates down the leg, with or without numbness or tingling. Some people also may experience muscle weakness. »
Such an injury can make it hard to perform even the most basic tasks. Thankfully, however, a number of treatments are available that can alleviate symptoms and get you back to doing the things you love to do.
Nonsurgical Versus Surgical Approaches
The first approaches for treatment are typically nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen and naproxen sodium, as well as epidural steroid injections and physical therapy. When those treatments aren’t effective enough, however, surgery might be an option for some patients, and can be especially helpful for those with:
- Pain or numbness and tingling that doesn’t improve after nonsurgical treatments
- Muscle weakness
- Symptoms that affect quality of life
Back to an Active Life
Tina Ryner moves a lot. Previously, she served as a firefighter and police officer, and now she lives on a farm in Albemarle County, where she enjoys riding horses. “I’m constantly lifting heavy stuff,” explains Ryner, 63. Over the years, she’d had several minor back injuries, but nothing she couldn’t treat on her own. Then one day, as she was walking at her home, she was hit suddenly with severe back pain. Ryner thought a few days of her usual combination of ice and NSAIDs would help, but the pain didn’t improve.
“I knew something was wrong when the pain went all the way down my leg and into my toes,” she explains. “I was just miserable. I couldn’t even sit on the edge of the bed to take my socks off. I couldn’t sit down to eat.” She also couldn’t go to her part-time job, work on her farm or ride her horses, so her quality of life was severely impacted.
Ryner tried medication, steroid injections and physical therapy, with no success. Then in April 2020, she saw Sentara Martha Jefferson neurosurgeon Osmond C. Wu, MD, who scheduled her for a surgical procedure the next day. “In the right patient with certain symptoms, surgery can be an excellent option—but it should be the last option considered,” says Dr. Wu. “Tina tried the appropriate nonoperative options before we performed surgery.”
The procedure involved two steps. First, Dr. Wu performed a hemilaminotomy, during which he removed a small portion of the lamina, which is a part of the vertebra. Then he performed a microdiscectomy to remove the protruding, or herniated, portions of Ryner’s disc.“The goal of this surgery is to remove the herniated portion of the disc that is compressing the nerve root, helping to relieve pain,” explains Dr. Wu.
Although the procedure can be performed with a traditional “open” incision, Dr. Wu used a minimally invasive approach, which allows for a smaller incision and can result in less pain. Ryner returned home the same day.
Most people feel relief immediately after surgery for a herniated disc, and recovery time is typically short.
Prior to surgery, Ryner’s pain was so severe that she had to ride to the hospital lying down in her boyfriend’s pickup truck—sitting was just too painful. “When I came out of surgery, I could sit in a wheelchair,” Ryner says. Although she didn’t need any physical therapy after her procedure, she did have to limit her movements and any heavy lifting—limitations she found to be challenging. “The hardest part was remembering I was at a higher risk for injury. I had to remember not to go ahead and do something I would normally do without thinking,” she says. “I took it very seriously because I didn’t want to reinjure myself.”
Ryner knew she wanted her surgery at Sentara Martha Jefferson, where she’d previously had cancer treatments. “I retired to this area for the good health care. Dr. Wu and his staff were absolutely awesome. They got me in the next day and made sure my insurance covered my surgery. I was absolutely so impressed. I have sent some of my friends to Dr. Wu, and they’ve been really pleased with him, too.”
Back to Biking
Jesse Kelly had dealt with lower back issues for several years, but when his entire right leg went numb in the summer of 2020, he knew he needed help. The 35-year-old Charlottesville resident enjoys riding his bike. Although he was still able to ride despite the numbness, his physical therapist noticed that his right calf wasn’t functioning at all. “I was really concerned about losing motor function,” Kelly recalls.
Physical therapy, medication and injections didn’t help his condition, and an MRI showed that Kelly had a herniated disc that was causing radiculopathy, or a pinched nerve along the spine. Sentara Martha Jefferson neurosurgeon David F. Slottje, MD, performed a minimally invasive microdiscectomy to remove the disc fragment pushing on Kelly’s spine. “Dr. Slottje got me in quickly,” Kelly says. “He spent a lot of time reviewing my MRI and going over my options.” The professionalism and safety protocols at Sentara Martha Jefferson during the COVID-19 pandemic also impressed Kelly. “It was my first time there as a patient,” he says. “I was really happy with the hospital. They took all the right precautions, and I felt really comfortable.”
Kelly returned home the day of his procedure. “It went really well,” he says. “Dr. Slottje’s team was really great, and I felt almost immediate pain relief after the surgery.” One day after the procedure, Kelly was up and walking.
After three months of physical therapy, Kelly’s calf function returned fully, and he was back on his bike. “It was a little bit like starting over,” he says. “It took a couple months, but now I’m back to where I was before things started acting up.” Dr. Slottje monitored Kelly’s progress through in-person and telehealth appointments. “He answered a lot of questions and talked me through things,” Kelly adds.
According to Dr. Slottje, it’s important to take the time to educate patients, so they know what to expect before and after surgery. “They need to know what should prompt a call to the office and what is normal during recovery from surgery,” he says. For instance, after surgery some patients may experience nerve pain flare-ups or muscle spasms, which can be treated with medications like muscle relaxers or steroids. “There can be a lot of worry about surgery. Providing reassurance and clear expectations can help relieve some of that anxiety,” he adds.
For Kelly, that clear communication from Dr. Slottje made all the difference. “He created good feedback between the two of us and made me feel comfortable,” Kelly says. “I’ve had surgeries in the past after which my doctors just had me report back to my primary care doctor, but Dr. Slottje and I had several follow-up visits. He talked to me about returning to full activities like biking and how to ease into those without concerns about reinjury. He was very encouraging.”
Sentara Martha Jefferson’s neurosurgeons can treat back pain associated with a number of conditions, including:
- Degenerative disc disease
- Herniated discs
- Spinal stenosis
Contact Sentara Martha Jefferson Neurosciences at 434-654-8960.