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.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The discs are pads that serve as "cushions" between the vertebral bodies,
which minimize the impact of movement on the spinal column.
Each disc is
designed like a jelly donut with a central softer component (nucleus pulposus).
Abnormal rupture of the central portion of the disc is referred to as a disc
The most common location for a herniated disc to occur is in the
disc at the level between the fourth and fifth lumbar vertebrae in the low back.
If the disc herniation is large enough, the disc tissue can press on the
adjacent spinal nerves that exit the spine at the level of the disc herniation.
The physical examination, imaging tests, and electrical tests can aid in the
diagnosis of a herniated disc.
Depending on the severity of symptoms,
treatments for a herniated disc include physical therapy, muscle relaxant
medications, pain medication, anti-inflammation medications,
local injection of
cortisone (epidural injections), and surgical operations.
How are the spine and its discs designed?
The vertebrae are the bony building
blocks of the spine. Between each of the largest parts (bodies) 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, is the sacrum,
followed by the tailbone (coccyx).
The bony spine is designed so that vertebrae
"stacked" together can provide a movable support structure while also protecting
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 the vertebral bodies 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). 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.
Epidural Cortisone Injections for Sciatica and Herniated Disc...Beneficial?
A majority of patients with sciatica from disc herniation
have resolution of their pain with various conservative measures,
including antiinflammatory and muscle-relaxant medications, exercises,
physical therapy, and time. However, some 10%-15% of affected
patients require surgical procedures to relieve the pain.