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Minimally Invasive Options for Lumbar Disc Herniation and Sciatica

Worldwide, about 577 million people suffer from low back pain. In the United States, upwards of 80% of all Americans will feel the stab of low back pain at some point during their lives. One of the common causes of this type of pain is a herniated disc, also known as a ruptured, bulging, or protruding disc.

In addition to lower back pain, a lumbar disc herniation often causes sciatica, which is a sharp, shooting pain that travels through your buttock and down the length of your leg. 

Sometimes, the problem resolves on its own after a few weeks of rest and physical therapy. When it doesn’t, you have some very effective minimally invasive treatment options. 

Dr. Jay Shah, our board-certified pain specialist at SamWell Institute for Pain Management in Colonia and Livingston, New Jersey, offers the most advanced evidence-based treatments available to stop your pain and restore your mobility. 

What happens when you herniate a disc

Nested between each of the 24 bony vertebrae stacked in your spine, you have gel-filled discs that act as cushions and shock absorbers. Each one is about half-an-inch thick, with a tough outer shell called the annulus and fluid center called the nucleus. 

As you age, the wear-and-tear of a lifetime can cause the annulus to give way and allow the nucleus to bulge out. A sudden injury can rupture the disc as well. If you’re overweight, sedentary, repeatedly put strain on your spine, drive long hours, or smoke, your chances of herniating a disc are greater than those who aren’t or don’t.

Once the nucleus protrudes past its boundary, it may touch, irritate, or compress a nearby nerve. When this occurs in your lumbar region (your lower back), the nerve most often affected is the sciatic nerve, which extends from your lower back and down the length of each leg.

This explains why the symptoms of a lumbar herniated disc aren’t confined to your lower back. It’s common to experience pain, weakness, numbness, and tingling anywhere along the path of the irritated sciatic nerve.

In extreme cases, you may even lose control of your bowels or bladder. 

Minimally invasive treatments for lumbar herniated discs

Dr. Shah is one of the country’s leading pain management experts, and he specializes in minimally invasive treatments. When rest and physical therapy don’t relieve your symptoms, he may suggest the following approaches.

Minimally invasive lumbar decompression (MILD®)

As you get older, disc tissues tend to degenerate, dry out, and lose height, causing the space in your spine to narrow — a condition called spinal stenosis. If this leads to irritation or compression of nearby nerves, you may experience pain, numbness, tingling, or weakness anywhere along the path of the nerve.

What once required open surgery to correct, Dr. Shah now skillfully addresses with a far-less traumatic procedure called minimally invasive lumbar decompression, or MILD, by Vertos Medical. He makes a tiny incision no bigger than the diameter of a pencil eraser to remove a small portion of your lamina, which is the bony arch of the affected vertebra. 

VertiFlex Superion

Another way to create more space in a narrowed spine is to add an expanding device. Rather than removing tissue like MILD does, the VertiFlex Superion procedure uses an H-shaped implant that expands once it’s in place, opening the area between your vertebrae and relieving the pressure on your nerves. 

Epidural steroid injection

Unlike oral pain medications that need to travel through your digestive system before they enter your bloodstream to offer only generalized pain relief, epidural steroid injections deliver instant relief at the precise location of your affected nerve. 

The injection contains lidocaine to numb the targeted area, as well as an anti-inflammatory steroid medication  to reduce the pain-causing inflammation at the exact site where the herniated disc exerts pressure on the nerve. This treatment may reduce your pain enough to allow you to participate more fully in rehabilitative physical therapy that resolves your herniated disc, and it can provide moderate to long-term relief of your pain. It can also be repeated to provide longer periods of pain relief.

Percutaneous discectomy

Sometimes, the best course of action to relieve your lumbar herniated disc pain is to shrink the bulging (or contained) herniated disc. Dr. Shah accomplishes this safely and precisely using a procedure called percutaneous disc discectomy. It’s also called “Scarless Discectomy,” as it doesn’t require any cuts or incisions, produces no scarring, and comes with little to no downtime.

He inserts a special needle into the center of the affected disc that allows him to remove some of the nucleus fluid and decompress the area.


If Dr. Shah determines that he needs to remove the part of the disc that’s bulging out and irritating your nerves, he may refer you to an orthopedic spine surgeon or neurosurgeon who is qualified and board-certified to perform a microdiscectomy. Although this procedure once required open surgery, minimally invasive techniques allow surgeons to remove some of the protruding tissue through a slender retractor that resembles a needle. 

Using real-time imaging technology, the surgeon guides the instrument to the herniated disc and removes excess tissue to decompress the surrounding nerves.

If you’re living with the pain of a lumbar herniated disc, you can get lasting relief without major surgery. To learn more, schedule an appointment online, or call us at either of our two New Jersey locations today. 

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