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A disc herniation or spinal disc herniation is an injury to the intervertebral disc between two vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain , pain or sensation in different parts of the body, and physical disability .
The McKenzie protocol also now includes flexion protocols and stresses the importance of differentiating whether flexion or extension improves patient's symptoms. As a result, McKenzie principles are used by many physical therapists in the treatment of low back pain, whereas Williams Exercises are no longer taught as a physical therapy protocol.
The McKenzie method is a technique primarily used in physical therapy.It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. [1] [2] [3] In 1981 he launched the concept which he called "Mechanical Diagnosis and Therapy (MDT)" – a system encompassing assessment, diagnosis and treatment for the spine and extremities.
Although structured exercises provide small, short-term benefit for leg pain, in the long term no difference is seen between exercise or simply staying active. [48] The evidence for physical therapy in sciatica is unclear though such programs appear safe. [3] Physical therapy is commonly used. [3]
Microdiscectomy (or microdecompression) is a minimally invasive surgical procedure in which a portion of a herniated nucleus pulposus is removed by way of a surgical instrument. [2] The purpose of this procedure is to relieve the pressure and reduce the local inflammatory reaction around a nerve root, caused by the herniated nucleus pulposus.
The endoscope features a slim working channel to guide instruments to the anatomy. The surgeon leads the endoscope through the working tube while in surgery. The camera emits pictures and/or video of the operating field to a monitor, while the surgeon uses special surgical instruments to remove the herniated disc material safely, with precision.
In most cases of herniated disks and stenosis, rest, injections or surgery have similar general pain-resolution outcomes on average after one year. In the United States , acute low back pain is the fifth most common reason for physician visits and causes 40% of missed work days. [ 8 ]
Surgery may be useful in those with a herniated disc that is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control. [17] It may also be useful in those with spinal stenosis. [18] In the absence of these issues, there is no clear evidence of a benefit from surgery. [17]
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