Disc Herniation Treatment in Castle Rock
What is a Disc Herniation?
A disc herniation (also called a herniated disc, slipped disc, or ruptured disc) occurs when the soft, gel-like center of a spinal disc pushes through a tear in the tough outer layer. When the herniated material presses on a nearby nerve root, it causes pain that radiates into the arm (from a cervical herniation) or leg (from a lumbar herniation). This radiating nerve pain is called radiculopathy - and when it affects the sciatic nerve roots in the lower back, it is called sciatica.
Not all disc herniations cause symptoms. Many people have herniations on MRI without any pain. A herniation becomes a problem when it compresses or irritates a nerve root, causing pain, numbness, tingling, or weakness in the arm or leg.
What Does a Disc Herniation Feel Like?
Lumbar (lower back) disc herniation:
Sharp or burning pain radiating from the lower back into the buttock, leg, or foot (sciatica)
Numbness or tingling in the leg or foot, often following a specific pattern
Weakness in the leg or foot - difficulty lifting the foot (foot drop) or pushing off while walking
Pain that is worse with sitting, bending forward, coughing, or sneezing
Back pain may or may not be present - some patients have only leg pain
Cervical (neck) disc herniation:
Pain radiating from the neck into the shoulder, arm, or hand
Numbness or tingling in the arm, hand, or fingers
Weakness in the arm or hand - difficulty gripping or lifting
Neck stiffness and pain that is worse with certain head positions
How is a Disc Herniation Different from Degenerative Disc Disease?
These are related but different conditions. A disc herniation is a specific event - material pushes out from the disc and compresses a nerve, causing radiating pain. Degenerative disc disease is a gradual process of disc breakdown that causes pain from the disc itself, typically without nerve compression. The treatments are different: herniations are usually treated with epidural injections targeting the compressed nerve, while DDD may be treated with Intracept, facet treatments, or other approaches depending on the pain generator.
How is a Disc Herniation Diagnosed?
Dr. Carrera's team evaluates disc herniations through a detailed history, neurological examination (testing reflexes, strength, sensation), and imaging. An MRI is the most useful study because it shows both the disc and the nerve roots. The team correlates what the MRI shows with your symptoms and exam findings to determine whether the herniation is the actual source of your pain.
It is important to note that many people have disc herniations on MRI without symptoms. A herniation on imaging does not automatically mean it is causing your pain. The clinical evaluation helps make that distinction.
When Should I Seek Immediate Medical Attention?
Most disc herniations can be managed on a non-emergency basis. However, seek immediate evaluation if you experience new or worsening loss of bowel or bladder control, rapidly progressive weakness in an arm or leg, severe numbness in the groin or saddle area, or weakness in both legs. These symptoms may indicate cauda equina syndrome, a rare but serious condition requiring urgent treatment.
How Are Disc Herniations Treated?
Conservative care: Many disc herniations improve on their own over 6 to 12 weeks. Initial treatment includes activity modification (avoiding movements that worsen the pain), anti-inflammatory medications (NSAIDs like meloxicam), nerve-calming medications (gabapentin, pregabalin), and a short course of oral steroids in some cases. Physical therapy is started once the acute pain begins to settle.
Transforaminal epidural steroid injection (TFESI): When pain is severe or not improving with conservative care, a transforaminal epidural injection delivers anti-inflammatory medication directly to the compressed nerve root. This is the most targeted type of epidural for disc herniations and can also help confirm which nerve is the source of pain. Most patients experience significant relief. The injection is performed in the office and takes about 2 to 5 minutes.
Interlaminar or caudal epidural: For patients with bilateral symptoms, multi-level herniations, or post-surgical disc herniations, an interlaminar or caudal epidural may provide broader coverage.
Spinal cord stimulation: For chronic radiculopathy from a disc herniation that persists despite injections and conservative treatment - particularly after spine surgery - spinal cord stimulation can provide significant relief.
Surgery: Surgery (microdiscectomy or laminectomy) is considered when there is significant or progressive weakness, cauda equina syndrome, or severe symptoms that have not improved after an adequate trial of non-surgical treatment. Dr. Carrera's team coordinates with spine surgeons when surgery is appropriate.
Do All Disc Herniations Need Treatment?
No. Many disc herniations, especially small ones that are not compressing a nerve, do not cause symptoms and do not need treatment. Even herniations that do cause symptoms often improve with time as the body naturally reabsorbs the herniated material. The decision to treat depends on the severity of your symptoms, whether there is nerve compression, and how much the pain is affecting your life.
Can a Disc Herniation Come Back?
Yes. Once a disc has herniated, there is a chance of recurrence at the same level, especially if the tear in the outer layer does not fully heal. Recurrence rates are estimated at about 5 to 15% after successful conservative treatment. Maintaining core strength, using good body mechanics, and avoiding heavy repetitive bending and lifting reduce the risk. If a herniation recurs and causes significant symptoms, the same treatment options are available.
Schedule an Evaluation
If you have arm or leg pain, numbness, or weakness that you suspect may be from a disc herniation, Dr. Carrera's team can evaluate your symptoms, review or order imaging, and recommend targeted treatment. For patients with severe acute symptoms, the team can arrange expedited access.