Endoscopic Spine Surgeon Dr. Kaixuan Liu with Atlantic Spine Center Says Spine is Susceptible to Injury; Offers Prevention Tips

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Herniated Spinal Disc? You Can Always Blame Evolution

Dr. Kaixuan Liu

The good news: statistics indicate less than 2 percent of patients with herniated discs require surgery and those who do experience more serious, chronic symptoms unresponsive to more conservative approaches now have a variety of advanced treatment options.

Backache? Crick or numbness in the neck? Could be a herniated spinal disc – “a common problem and one we likely share with other animals, including the dinosaurs,” according to renowned spinal surgeon Kaixuan Liu MD, PhD., referring to a study published recently in a 2020 issue of the journal Scientific Reports. “Paleontologists have determined dinosaur species had spines with intervertebral discs – much like those of humans, meaning some of these animals could well have slipped or ruptured a disc during their lifetime,” says Dr. Liu, founder of Atlantic Spine Center, based in New Jersey and New York.

Located between the spine’s bony vertebrae, discs are gel-filled capsules that serve as natural “shock absorbers,” Dr. Liu says. “They give the spine its mobility and flexibility and prevent vertebrae from rubbing together.”

A disc may “slip” if the tissue connection between disc and spinal bone is torn (avulsed). They rupture when their outer membrane actually cracks and the inner-core material oozes out, oftentimes pressing against surrounding nerves. Sciatica, for example, is a complication that develops when a lumbar disc herniates and inflames the sciatic nerve, resulting in pain in the lower back and buttocks and sometimes numbness in one or both legs. Less frequently, a herniated disc may compress the spinal cord, prompting it to swell, which causes balance problems, difficulties walking and using fine motor skills, and cramping in arms and legs.

The dinosaur scientists say that this intervertebral-disc spinal arrangement in humans and mammals generally is more susceptible to damage than the ball-and-socket spines in other species, including reptiles.

Dr. Liu agrees. “An imperfect evolutionary process has left us with discs, which may be the reason why an estimated 80 percent of all adults in the United States will experience back or neck pain at some time in their lives,” he says.

Back injuries; undue spinal stress from heavy lifting, sports, or repetitive activities; even the normal aging process, which dries out discs and makes them brittle, can force discs out of their normal position in the spinal column or cause them to rupture.

Because the spine is a complex system, of nerves, muscles, cartilage, ligaments, and bone, pinpointing the source of a patient’s neck or back pain is not always an easy process, “but disc herniation is frequently the underlying cause of the discomfort,” says Dr. Liu. In fact, the annual incidence of herniated discs is as high as 20 cases per 1,000 persons. Dr. Liu uses a combination of neurological examination, including testing of muscles, reflexes, and walking capability, and imaging, such as CT, MRI, and myelogram, to diagnose a spinal problem.

The good news: statistics indicate less than 2 percent of patients with herniated discs require surgery and those who do experience more serious, chronic symptoms unresponsive to more conservative approaches now have a variety of advanced treatment options.

At the 2018 annual meeting of the Radiological Society of North America, scientists reported that a minimally invasive procedure involving pulsed radiofrequency, delivered by a CT-guided electrode, was proving effective for controlling nerves that send pain signals from a herniated disc in the lower (lumbar region) of the back and for reducing inflammation. The therapy, they said, helped patients avoid surgical removal of the offending disc and subsequent fusion of lumbar vertebrae. Meanwhile, researchers, writing in a 2020 issue of Science Translational Medicine, indicated success with a “two-step technique” to repair ruptured spinal discs – first, by re-inflating them with hyaluronic acid and then, secondly, by sealing the crack in the disc’s membrane with a collagen gel.

Herniated discs generally respond to more conservative therapies, such as hot and cold compresses, medication, muscle relaxants, light exercise to strengthen back and stomach muscles and improve range of motion, physical therapy, and “avoidance of activities that aggravated the disc in the first place,” Dr. Liu says. “Oftentimes, the injured disc will resolve on its own – without treatment.”

“Many experts in the medical community believe that, over time, the material protruding from a herniated disc can shrink, either because of natural processes that enable the body to reabsorb a portion of it or because of spinal extension exercises,” Dr. Liu explains. “As the ruptured disc gets smaller, it is less likely to irritate the nerve roots around it.”

The best medicine, of course, is protecting spinal discs from damage, Dr. Liu says. “Although we cannot stop the aging process, we can minimize other risks.” He offers the following tips for maintaining a healthy spine:

  • Keep weight at a level appropriate to one’s height. Excess weight puts more stress on the spine.
  • Stop smoking. Scientists reported a connection between smoking and degenerative disc disease, especially in the neck, during a 2016 meeting of the Association of Academic Physiatrists.
  • Exercise regularly to strengthen both back and abdominal muscles. Well-conditioned abdominal muscles provide the back with important support and enhance posture.
  • Practice good posture when walking or standing –- chin back, shoulders back and stomach pulled in. If standing for a long period of time, periodically place a foot up on a step or chair rung to take stress off the back.
  • Lift heavy objects properly by squatting and using the legs rather than bending forward and putting stress on the back.

“Remember you have more advantages than the dinosaurs. If you do develop back or neck pain that affects quality of life and does not resolve within a short amount of time, you can always contact a spinal specialist for help,” Dr. Liu says.

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. http://www.atlanticspinecenter.com, http://www.atlanticspinecenter.nyc

Kaixuan Liu, MD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery at Atlantic Spine Center.

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