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Herniated disc lumbar spine |
Evaluation may start with a plain X-ray but this will not show soft tissue or disc herniations. This is usually obtained as a baseline to look at general anatomy as well as evaluate any bone lesions. Generally the MRI scan is the gold standard for disc evaluation. High quality scans may visualize not only the disc fragments but also enable the trained observer to follow the entire path of the nerve root as it exits the spine.
Occasionally a CT scan and myelogram with dye may be done to evaluate the spinal sac especially if the individual cannot undergo a magnetic scan due to a pacemaker or the like. Sometimes injectable dye may be used in conjunction with a MRI to evaluate scar tissue around a nerve root. A good history and physical exam will usually make the diagnosis and the above tests will confirm it.
Treatment is widely variable. Rest and anti-inflammatory drugs are the mainstays of treatment. After the initial acute, phase physical therapy may help strengthen the core muscles and prevent further flare up. Modification of activity may help the pain significantly. Sometimes epidural steroid injections can help and are best done under X-ray control. Once the exact nerve root is identified a nerve root block can be done placing the steroid medication around the nerve root to maximize its effect.
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