Overview
A herniated disc occurs when the soft inner material of an intervertebral disc pushes through a tear in the outer ring (annulus fibrosus), pressing on nearby nerve roots or the spinal cord. This can produce intense pain, numbness, or weakness radiating into the arm (cervical disc) or leg (lumbar disc). Disc herniations are among the most common causes of radiculopathy — nerve pain that travels along a specific nerve pathway. Dr. Migdale treats herniated disc disease with a spectrum of image-guided interventional techniques designed to reduce nerve inflammation, restore function, and avoid surgery wherever possible.
How a Disc Herniation Causes Pain
Herniated discs cause pain through two mechanisms: direct mechanical compression of nerve roots by the herniated material, and chemical irritation of the nerve from inflammatory proteins released by the disc. This is why anti-inflammatory treatments — particularly epidural steroid injections — are often highly effective: they address the inflammatory component directly at the source.
The Difference Between a Bulge and a Herniation
A disc bulge is a broad, circumferential expansion of the disc beyond its normal boundaries. A herniation is a more focal protrusion, where disc material breaks through the outer wall. Both can compress nerve roots, but herniations tend to produce sharper, more specific nerve pain. A disc extrusion is an even more significant herniation where the disc material has fully escaped the outer ring.
Treatment Approach
Dr. Migdale's approach to herniated disc disease begins with a thorough evaluation to correlate imaging findings with the patient's specific symptoms and neurological examination. For most patients, a targeted epidural steroid injection at the exact level and side of the herniation — using fluoroscopic or ultrasound guidance — provides the fastest and most effective relief. For patients with persistent pain after injections, or for those with complex disc pathology, neuromodulation or referral for surgical evaluation may be considered.