Q. I'm a 41-year-old male. A recent myelogram CT has revealed a herniated disc at T7-8. The report states "there is a abnormal epidural soft tissue on the right which is suspicious for a right sided disc herniation. It correlates with the patient's symptoms. It deforms the anterior aspect of the thoracic cord. No other focal disc abnormality is evident. No foraminal stenosis is evident." What are my options? What are the latest surgical techniques for this ailment? I've been putting up with back pain for fourteen months, and I'm tired of it.

A. The report indicates you have a bulging disc in the spine, approximately the mid-back. The discs are shock absorbers between the vertebrae, and their normal anatomy provides space between adjacent vertebrae so that nerves can exit from the spinal canal and reach their destinations. Disc problems can occur due to aging or trauma, in which a break or tear occurs in the tough outer layer of the disc (the annulus) and allows the softer inner material (nucleus pulposis) to protrude. This protrusion causes physical pressure of the disc on the exiting nerve, and pain can be felt along the entire course of the nerve.

Standard initial treatment for a known or suspected disc problem is to reduce activity, at least avoiding activities that put undue stress on the spine, medication to reduce inflammation and pain, and sometimes directed treatment such as physical therapy. About 80% of such cases show significant improvement over 3 months. In those that fail to improve, further studies are usually needed such as you describe, the use of CT or MRI or nerve studies to get a better picture of the anatomy involved. This can then lead to more specific intervention such as epidural steroid injection, heat-based techniques to shrink the abnormal tissue, or surgery to remove the damaged area of the disc. Finding the correct treatment for an individual is often difficult, and pain management is critical throughout the course of treatment.

HELPFUL WEBSITES:

http://www.nlm.nih.gov/medlineplus/backpain.html

http://www.americanspine.com/index.html

http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=10&topcategory=Spine

MEDICAL ARTICLES (AVAILABLE THROUGH YOUR LOCAL HOSPITAL LIBRARY):

"When You Have a Herniated Disc." American Family Physician. 59(3): 587-588. February 1, 1999.

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