Herniated Disc

A herniated disc is a medical condition which may be due to trauma, lifting injuries, but in many cases,  a degenerative disc may herniate without apparent reason.

The vertebrae that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep it flexible, however when a disc is damaged, it may bulge or break open creating a herniation.

Most herniated discs affect the lower back but you can have a herniated disc in any part of your spine. Most minor herniations heal within a few weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or annular tears are generally effective. Severe herniations may require surgical intervention.

This condition is sometimes referred to as a slipped disc, however this term is not medically accurate as the intervertebral discs are fixed in position between the vertebrae and cannot really "slip".

Causes
Disc herniations can result from general wear and tear of the intervertebral disc. As you get older, your intervertebral discs dry out and are not as flexible.

Disc herniations can also be a result of injury to the spine.  From an accident or traumatic circumstance, a shocking occurrence can cause the jelly-like contents to be forced out through the tears or cracks in the outer layer of the intervertebral disc. This causes the intervertebral disc to bulge, break open, or break into pieces.

Herniation of the contents of the intervertebral disc into the spinal canal often occurs when the front side of the disc is compressed while sitting or bending forward and the disc contents get pressed against the tightly stretched and thinned membrane on the back side of the disc.  The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, thus producing intense and usually disabling pain and other symptoms.

Symptoms
The symptoms can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting neck or low back pain that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as the patients present with undefined pains in the thighs, knees, or feet.

Other herniated disc symptoms may include sensory changes such as numbness, tingling, muscular weakness, paralysis, and affection of reflexes.

If the herniated disc is in the cervical region, patients may present with pain or numbness in the neck, chest, arms, and hands.  If the herniated disc is in the lumbar region the patient may present with pain or numbness in the legs and feet or may also experience sciatica due to irritation of one of the nerve roots of the sciatic nerve. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous or at least is continuous in a specific position of the body.

It is possible to have a herniated disc without any pain or noticeable symptoms, depending on its location.  Typically, symptoms are experienced only on one side of the body. If the herniation is very large and presses on the spinal cord or the cauda equina in the lumbar region, affection of both sides of the body may occur, often with serious consequences. Compression of the cauda equina can cause permanent nerve damage or paralysis. The nerve damage can result in loss of bowel and bladder control as well as sexual dysfunction.

Treatment
Often a herniated disc will heal on its own as the jelly-like material inside the intervertebral disc is broken down and absorbed by the body, a process called resorption. For this reason, nonsurgical treatment is typically recommended before herniated disc surgery is considered.

Initial herniated disc treatment usually consists of non-steroidal anti-inflammatory pain medication.  An alternative, often employed treatment is the injection of cortisone into the spine adjacent to the suspected pain generator known as “epidural steroid injection”. Epidural steroid injections may result in some improvement in radicular lumbar pain between 2 and 6 weeks following the injection.

Ancillary approaches, such as rehabilitation, physical therapy, anti-depressants, and, in particular, graduated exercise programs, may all be useful adjuncts to anti-inflammatory approaches.

It is estimated that only 10% of people with herniated disc problems that cause noticeable symptoms eventually have surgery.  The most common and effective herniated disc surgery is discectomy in which disc material is removed through an incision. A discectomy is done mostly to relieve pain and other symptoms in the leg. It is not recommended if the herniated disc only causes back pain.


This information is not designed to replace a physician's independent decision about the appropriateness or risks of a procedure for a given patient. Always consult your doctor about your back problem or medical conditions. Life Spine does not provide medical advice, diagnosis or treatment.