Breakdown of Herniated Disks

[Tabascocat]

I decided to give an overview of a disc injury, Cliff Notes style so those can draw their own conclusions from facts to be presented.

(I am NOT a MD but did attend Medical School(UTHSC) for two years before I called it quits. My wife is a Nurse Practitioner doing work in the ER and OR from infants to the elderly. She is currently at Texas Childrens in Houston and knows her stuff. This is a compilation of my past and her current studies)

Spinal discs are rubbery pads located between the vertebrae and are flat and circular. They are held in place by ligaments sandwiched in and around muscle tissue. There is little room for them to slip or move in there. When someone says "I slipped my disc", it does not mean the whole disk just moved out completely.

In our early years, these are fluid-filled and feel like gels. As we get older, they change. At middle age, they become tough and unyielding, feels like hard rubber. As we increase with age, we are more prone to injury.

A herniated disc means that its inner material swells and pushes through the outer membrane. It can become distorted or bulge in weak spots along the outer membrane. This can lead to pressure against some nerves.

A rupture is extruding further causing pressure on the cord itself or the nerves that radiate from it.

Early symptoms include spasms in the lower back and/or neck. If nerves are affected, pain radiates into the arm or leg. Disc herniation's are usually a further development from a previous existing disc protrusion. This means there is a good chance that this is not a new development.

Prognosis

Minor herniation's heal in a few weeks with anti-inflammatory medication. The more advanced the injury is, the more severe the treatment. Complete ruptures require surgical intervention because some will not heal on their own.

Discs can be torn, ripped, herniated and degenerated but it can not be slipped out completely from between the vertebrae.

These injuries can occur in the thoracic, cervical and lumbar regions but most are lumbar(between the 4th and 5th vert or between the 5th and sacrum). This affects the thigh which Romo complained about.

Since his MRI is done, next step should be a Myelogram followed by an Electromyogram(EMG) and a Nerve Conduction Studies(NCS).

Even if surgery isn't necessary, it takes a few months to show reasonable results. NSAIDS and Cortisone might be an option if there was not a rupture. The epidurals take 2-6 weeks to go into full effect. Also, Romo's mobility will be severely effected with intense pain.

Either way you slice it, Romo is done for the season. Garrett is blowing smoke and mirrors but there is no chance he plays next week or the week after.

Now, I don't know the extent of his injury. It might be minor but that is enough to hold him out IMO. We are stuck with Orton for better or for worse.

 

[ShiningStar]

wow, thank you for that post.

 

[Reverend Conehead]

Thanks for the info. Do you think he'll be able to fully recover for next season good as before? Or is the beginning of a decline or even the end of his career now?

 

[Tabascocat]

Thanks for the info. Do you think he'll be able to fully recover for next season good as before? Or is the beginning of a decline or even the end of his career now?

I think he will be fine by OTA's, especially if they go the surgical route. If they decide to let it heal on its own, that could pose problems down the road. Romo is at that age of damned if you do and damned if you don't. It would be riskier to let it heal naturally, he does not have time on his side. Get the surgery and get on with football in 2014.

Everyone heals differently and I do not know to what extent his injury is. If it is indeed a rupture, then get the surgery. If it is not and only experiencing spasms, see if they can get through that short-term and let it heal in the off-season.

None of us can give a good prognosis not knowing what exactly is going on.

 

[CATCH17]

I have a herniated disk and I never stopped working out since I got it.


I don't play any contact sports but it doesn't effect me once I start moving.

The pain used to be bad but it's pretty much gone away which leads me to my main point.


If Romo can deal with the pain he's definetely playing. The thing is it may not even hurt.

 

[T-RO]

Garrett is blowing smoke and mirrors but there is no chance he plays next week or the week after.

Garrett is doing nothing but falling in line with his boss, Jerry.

 

[dupree89]

Here is a brief article I found about David Garrard and his herniated discs at L-4 / L-5.
I realize they are all different but I thought maybe some people would like to see it. This was from a few years ago.

http://espn.go.com/nfl/story/_/id/7...-option-oakland-raiders-jason-campbell-injury

 

[T-RO]

I have a herniated disk and I never stopped working out since I got it.


I don't play any contact sports but it doesn't effect me once I start moving.

The pain used to be bad but it's pretty much gone away which leads me to my main point.


If Romo can deal with the pain he's definetely playing. The thing is it may not even hurt.

Romo has had broken ribs and other injuries and downplayed the pain... He didn't downplay this. It's clear that It hurts a ton.

 

[Tabascocat]

I have a herniated disk and I never stopped working out since I got it.


I don't play any contact sports but it doesn't effect me once I start moving.

The pain used to be bad but it's pretty much gone away which leads me to my main point.


If Romo can deal with the pain he's definetely playing. The thing is it may not even hurt.

Yea, there is definitely different levels of injury here. We don't know to what extent Romo faces. Some can be played through with sufficient medication for a game or two. Some require surgery and some need weeks to heal on their own.

Again, we do not know what is exactly wrong with his back. If it was a rupture, he will not play, guaranteed 100%. If it is minor inflammation and it did not break through the outer core, it is possible he can play through it.

One thing I can tell you is....Romo is in a lot of pain right now regardless of the extent of the injury. Dealing with pain is one thing, but possibly furthering damage is another.

We can all speculate but until we see what the exact injury is....it is all speculation on our parts.

 

[TheDude]

This injury isnt like sprain or broken rib. Sometimes it freezes involuntarily and you cant move or breathe. Dont know his extent., prednisone shots are are fn fantastic though

 

[Tabascocat]

This injury isnt like sprain or broken rib. Sometimes it freezes involuntarily and you cant move or breathe. Dont know his extent., prednisone shots are are fn fantastic though

If I remember correctly, corticosteroids and lung problems don't mix well(collapsed lung). Prednisone is used for Romo's injury but not sure it is the best drug of choice for him from past history. I realize it is used for asthma but I am almost positive it would not be given to Tony. There are are other steroid options to choose from with less side effects, I think. It has been awhile

 

[dupree89]

this is posted on USATODAY.COM

Turns out, Dallas Cowboys quarterback Tony Romo's back injury, aggravated during Sunday's 24-23 comeback win against the Washington Commanders, will shelve the 33-year-old quarterback for the rest of the season, a person familiar with Romo's injury told USA TODAY Sports.
The person spoke on condition of anonymity because the medical details were supposed to remain confidential.

http://www.usatoday.com/story/sport...-romo-injury-dallas-cowboys-nfc-east/4180891/

 

[Fmart322]

Here is a brief article I found about David Garrard and his herniated discs at L-4 / L-5.
I realize they are all different but I thought maybe some people would like to see it. This was from a few years ago.

http://espn.go.com/nfl/story/_/id/7...-option-oakland-raiders-jason-campbell-injury

Good read.

 

[WPBCowboysFan]

Its hard to say what the situation is without knowing the extent of the injury. Disc problems are very limiting for the most part - at least initially.

But here is the thing that makes it hard to know about Romo - if he hurt it during the game and still played its hard to see it as something that keeps him down in a significant manner. Is it a previous injury and he really just "tweaked" it as he said? If this is the case he might be able to play by Sunday. If its a new significant injury it would be close to impossible for him to perform on Sunday.

I herniated a disc in my back when I was 25. It was bad for the first 6 months. All the prescribed rest by the doctors to allow it to heal and cortisone injections. After that 6 months I began to get back to normal and have played softball for years and lift and move heavy stuff all the time. Once it sorta heals you know how to treat it and you know when you "aggravate" it to take it easy for a few days.

If Romo's is a "new" injury its hard to see him playing on Sunday. If he just aggravated a former injury then it seems like a possibility IMO.

 

[Section446]

As someone who's had a herniated disc, I can tell you that it sucks, and is crippling at times. The only cure (if you don't need surgery) is time and rest.

 

[pgreptom]

I have a herniated disk and I never stopped working out since I got it.


I don't play any contact sports but it doesn't effect me once I start moving.

The pain used to be bad but it's pretty much gone away which leads me to my main point.


If Romo can deal with the pain he's definetely playing. The thing is it may not even hurt.

Let's be honest - if Witten had to help Romo off the plane and to his car.. it hurts.

 

[Section446]

I have a herniated disk and I never stopped working out since I got it.


I don't play any contact sports but it doesn't effect me once I start moving.

The pain used to be bad but it's pretty much gone away which leads me to my main point.


If Romo can deal with the pain he's definetely playing. The thing is it may not even hurt.

There are different levels of herniated discs though.

 

[WPBCowboysFan]

Owner Jerry Jones isn’t ready to give up hope, either.

“All I’m saying is he has back spasms, symptoms that we’re treating as we go along in the week to see if he will play,” Jones said late Monday evening. “There is nothing structurally that will rule him out if he feels good and is cleared to play. Nothing.”

 

[tyke1doe]

Thanks for this post, dexter.
I'm curious why you didn't complete medical school? If it's not too private, do you mind sharing? If not, I understand.
Thanks.

 

[Doc50]

I decided to give an overview of a disc injury, Cliff Notes style so those can draw their own conclusions from facts to be presented.

(I am NOT a MD but did attend Medical School(UTHSC) for two years before I called it quits. My wife is a Nurse Practitioner doing work in the ER and OR from infants to the elderly. She is currently at Texas Childrens in Houston and knows her stuff. This is a compilation of my past and her current studies)

Spinal discs are rubbery pads located between the vertebrae and are flat and circular. They are held in place by ligaments sandwiched in and around muscle tissue. There is little room for them to slip or move in there. When someone says "I slipped my disc", it does not mean the whole disk just moved out completely.

In our early years, these are fluid-filled and feel like gels. As we get older, they change. At middle age, they become tough and unyielding, feels like hard rubber. As we increase with age, we are more prone to injury.

A herniated disc means that its inner material swells and pushes through the outer membrane. It can become distorted or bulge in weak spots along the outer membrane. This can lead to pressure against some nerves.

A rupture is extruding further causing pressure on the cord itself or the nerves that radiate from it.

Early symptoms include spasms in the lower back and/or neck. If nerves are affected, pain radiates into the arm or leg. Disc herniation's are usually a further development from a previous existing disc protrusion. This means there is a good chance that this is not a new development.

Prognosis

Minor herniation's heal in a few weeks with anti-inflammatory medication. The more advanced the injury is, the more severe the treatment. Complete ruptures require surgical intervention because some will not heal on their own.

Discs can be torn, ripped, herniated and degenerated but it can not be slipped out completely from between the vertebrae.

These injuries can occur in the thoracic, cervical and lumbar regions but most are lumbar(between the 4th and 5th vert or between the 5th and sacrum). This affects the thigh which Romo complained about.

Since his MRI is done, next step should be a Myelogram followed by an Electromyogram(EMG) and a Nerve Conduction Studies(NCS).

Even if surgery isn't necessary, it takes a few months to show reasonable results. NSAIDS and Cortisone might be an option if there was not a rupture. The epidurals take 2-6 weeks to go into full effect. Also, Romo's mobility will be severely effected with intense pain.

Either way you slice it, Romo is done for the season. Garrett is blowing smoke and mirrors but there is no chance he plays next week or the week after.

Now, I don't know the extent of his injury. It might be minor but that is enough to hold him out IMO. We are stuck with Orton for better or for worse.

Several points in this post are erroneous.

Herniation is rupture of the outer fibrous ring (annulus fibrosus) which then causes extrusion of the inner gelatinous material (nucleus pulposus).
Rupture and herniation are identical, and this is not caused by swelling, but by degeneration or trauma.

Herniation certainly distorts the anatomy locally, but there is not necessarily nerve root entrapment. The gelatinous material eventually reabsorbs, and discomfort from that pressure resolves. Steroids and non-steroidal anti-inflammatory medication help to resolve the swelling and subsequent pressure, but do not bring about healing. Steroid injections are likely to reduce swelling and pressure rapidly - within hours to days, and local anesthetic injections are effective immediately.

The serious consequence of of a tear (or herniation) of the outer fibrous ring is displacement of the fibrous material in such a way to cause direct entrapment of a spinal nerve, which results in significant pain and and dysfunction along the entire path of the nerve. If there are no radiating neurological symptoms, then there is no nerve entrapment, and the injury is not serious and requires no surgery. Furthermore, even passive range of motion may displace a fibrous component which is compressing a nerve, causing the nerve to then be decompressed and relieving the neuropathy.

An MRI shows the details of this anatomy, and no further testing is needed if there are no significant distal nerve symptoms (radiculopathy).

So, it is feasible that such an injury may NOT require surgery or even be very limiting within a few days of its occurrence. You or your quarterback may be able to carefully go back to work.