Herniated disc in the cervical spine, lumbar spine, and lumbar spinal canal stenosis

A herniated disc is a benign degenerative condition of the intervertebral discs. It can occur after trauma, but this is rare. Disc herniation is most common in the lumbar spine, also occurs in the cervical spine, and is least common in the thoracic spine.
The natural course of disc herniation is benign, and the prognosis without surgery is good. Most patients recover from symptoms within three months without surgical intervention.

General

Disc herniation most often presents with central pain symptoms radiating to surrounding areas. In the lumbar spine, this pain can radiate to the sacrum, pelvis, hips, buttocks, groin, and upper thighs. In the cervical spine, it often radiates to the shoulder blades, shoulders, and neck. These symptoms are caused by pain signals from connective tissue and are referred to as nociceptive pain.

Cases requiring surgery

At the Department of Neurosurgery [Heila- og taugaskurðdeild] at Landspítali, neurosurgeons only treat cases that require surgery to release or relieve nerve root pain in the arms or legs.

Most patients undergoing surgery have nerve root symptoms from the lower back due to disc herniation or lumbar spinal canal stenosis. The same issues can occur in the cervical spine, though in a smaller patient group.

Guidelines for assessing surgical benefit

The general practitioner is responsible for diagnosing and treating patients and referring them to a neurosurgeon to assess surgical benefit if needed.

General practitioners should follow the protocols set by neurosurgeons regarding diagnosis and can refer to the flowchart for nerve root compression in the spine (.pdf)(in Icelandic). The procedures are based on:

• Medical history

• Physical examination

• Reassessment

• Confirmed nerve compression on MRI

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