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.
Occasionally, disc herniation is incidentally detected when a test such as an
MRI is performed for other reasons. If no symptoms are present, no particular
treatment is necessary.
Depending on the severity of symptoms, treatments for a herniated disc
include physical therapy, muscle relaxant medications, pain medications,
antiinflammation medications, local injection of cortisone (epidural
injections), and surgical operations. In any case, all people with a disc
herniation should rest and avoid reinjuring the disc. Sometimes, even people
with relatively severe pain early on can respond to conservative measures
without the need for surgical intervention.
There are now a variety of surgical approaches to treat disc herniation. Each
type of operation is customized to the individual situation and depends a great
deal on the condition of the spine around the disc affected. Surgical options
include microdiscectomy using small surgical instruments and open surgical
repair (either from a posterior or anterior approach). Urgent operation can be
necessary when cauda equine syndrome is present (described above).
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
herniation.
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, antiinflammation medications, local injection of
cortisone (epidural injections), and surgical operations.
Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Cauda equina syndrome is a medical emergency condition that is caused by the uncommon compression of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include lower back pain, tingling and/or numbness in the buttocks and lower extremities, bowel or bladder incontinence, and weakness in the legs. Causes of cauda equina syndrome include herniated discs, hematomas, or infection. Treatment is generally prompt surgery.
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