Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
The discs of the spine serve as "cushions" between each
The discs are designed somewhat like a jelly donut.
Degeneration (deterioration) of the disc makes the disc more
susceptible to herniation (rupture), which can lead to localized or
Sciatica can result from disc herniation when nerves
in the low back are irritated.
How is the spine designed?
The vertebrae are the bony building blocks of the spine. Between each of the largest part of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back (thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In addition, in the mid-buttock beneath the fifth lumbar vertebra, are
five sacral vertebrae -- usually fused as the sacrum bone followed by the tailbone (coccyx).
What is the purpose of the spine and its discs?
The bony spine is designed so that vertebrae "stacked" together can provide a movable support structure. The spine also protects the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a spinous process, which is a bony prominence behind the spinal cord that shields the cord's nerve tissue. The vertebrae also have a strong bony "body" in front of the spinal cord to provide a platform suitable for weight-bearing.
The discs are pads that serve as "cushions" between each vertebral body that serve to minimize the impact of movement on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus). With injury or degeneration, this softer component can sometimes rupture (herniate) through the surrounding outer ring (annulus fibrosus) and irritate adjacent nervous tissue. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.
Picture of herniated disc between L4 and L5
Cross-section picture of herniated disc between L4 and L5
Picture of stapled incision post-surgery
Reviewed by Catherine Burt Driver, MD on 1/13/2012
The treatment of radiculopathy ranges from nonsurgical
(medical) management to surgery. Medical management of radiculopathy includes patient
education of the condition, medications to relieve pain and muscles spasm, cortisone
injection around the spinal cord (epidural injection), physical
therapy (heat, massage, ultrasound, electrical stimulation), and rest
(not strict bed rest, but avoiding re-injury). With unrelenting pain,
severe impairment of function, or incontinence (which can indicate
spinal cord irritation), surgery may be necessary. The operation
performed depends on the overall status of the spine and the age and
health of the patient. Procedures include removal of the herniated
discwith laminotomy (producing a small hole in the bone of the spine
surrounding the spinal cord), (removal of the bony wall adjacent to the nerve tissues),
by needle technique through the skin (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.