Herniated Disc A herniated disc is a medical condition affecting the spine due to trauma or lifting injuries or can result from a degenerative disc. Contact us today to learn more about the condition and treatment of your herniated disc. The bones or 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 the spine 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. Sometime it happens in the neck (cervical spine) rarely in the upper back (thoracic spine),  mostly you will hear the term “Lumbar Spine”, which means lower back. Most minor herniations heal within a few weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. Severe herniations may not heal on their own and may require surgical intervention. The condition sometime is referred to as a slipped disc, however this term is not medically accurate as the spinal discs are fixed in position between the vertebrae and cannot really "slip". Herniated Disc Symptoms Herniated disc 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 come with undefined pains in the thighs, knees, or feet.

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

If the herniated disc is in the lumbar region the patient 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.

Causes of Disc Herniations:

Disc herniations can result from general wear and tear of the disc. As you get older, your discs dry out and aren't as flexible.
Injury to the spine.  From an accident or traumatic circumstance,  a shocking occurrence can cause the gel inside the disc to be forced out through the tears or cracks in the outer layer of the disc. This causes the disc to bulge, break open, or break into pieces.
However, herniations often result from jobs that require lifting. Traumatic injury to lumbar discs commonly occurs when lifting while bent at the waist, rather than lifting with the legs while the back is straight. Minor back pain and chronic back tiredness are indicators of general wear and tear that make one susceptible to herniation on the occurrence of a traumatic event, such as bending to pick up a pencil or falling.

Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (annulus fibrosis) on the posterior side (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.
When a herniated disc presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels. A herniated disc in the lower back can cause pain and numbness in the buttock and down the leg. This is called sciatica; Sciatica is the most common symptom of a herniated disc in the low back.

If a herniated disc is not pressing on a nerve, you may have a backache or no pain at all.
If you have weakness or numbness in both legs, along with loss of bladder or bowel control, seek medical care right away. This could be a sign of a rare but serious problem called cauda equina syndrome.

Diagnosis:

Diagnosis is made by a practitioner based on the history, symptoms, and physical examination. At some point in the evaluation, tests may be performed to confirm or rule out other causes of symptoms such as spondylolisthesis, degeneration, tumors, metastases and space-occupying lesions, as well as to evaluate the efficacy of potential herniated disc treatment options.

Imaging:

X-ray: Although traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, are still used to confirm or exclude other possibilities such as tumors, infections, fractures, etc. In spite of these limitations, X-ray can still play a relatively inexpensive role in confirming the suspicion of the presence of a herniated disc. If a suspicion is thus strengthened, other methods may be used to provide final confirmation.

Computed Tomography Scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays. It can show the shape and size of the spinal canal, its contents, and the structures around it, including soft tissues. However, visual confirmation of a disc herniation can be difficult with a CT.

Magnetic Resonance Imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors. It shows soft tissues even better than CAT scans. An MRI performed with a high magnetic field strength usually provides the most conclusive evidence for diagnosis of a disc herniation. T1-weighted images allow for clear visualization of protruded disc material in the spinal canal.

Myelogram: An x-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces. By revealing displacement of the contrast material, it can show the presence of structures that can cause pressure on the spinal cord or nerves, such as herniated discs, tumors, or bone spurs. Because it involves the injection of foreign substances, MRI scans are now preferred in most patients. Myelograms still provide excellent outlines of space-occupying lesions, especially when combined with CT scanning (CT myelography).

Electromyogram and Nerve conduction studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves, and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury, or whether there is another site of nerve compression. EMG/NCS studies are typically used to pinpoint the sources of nerve dysfunction distal to the spine.

The majority of herniated discs will heal themselves in about six weeks and do not require surgery.
Initial herniated disc treatment usually consists of non-steroidal anti-inflammatory pain medication, An alternative often employed is the injection of cortisone into the spine adjacent to the suspected pain generator, a technique known as “epidural steroid injection”. Epidural steroid injections may result in some improvement in radicular lumbosacral 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.

Because inflammation usually fades over time, about 50% of people with a herniated disc in the low back recover within 1 month. And within 6 months, most people recover. Only 10% of people with herniated disc problems that cause noticeable symptoms eventually have surgery.

Often a herniated disc  heals on its own as the jellylike material (nucleus) inside the 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.

Nonsurgical herniated disc treatment is intended to help you return to your daily activities and usually includes:

Education. Learn how to take care of your back, which may include training in pain and symptom control. Your doctor may recommend physical therapy. A physical therapist can provide treatment with physical or mechanical means-such as through exercise or heat-and teach you exercises to do at home to strengthen the muscles that support your lower back.

Rest. Your doctor may recommend a short period of rest or reduced activity followed by a gradual increase in activity.

Pain relief. Some people can deal with pain without medicine if they know there is a good chance it will go away on its own. But you can use medicine to control pain and inflammation. Pain medicines include:

• Nonprescription and prescription pain relievers.
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
  
• Muscle relaxants.
  
• Corticosteroids.
  
• Opioids.
  
• Antidepressants.
  

Exercise. Keep active and use exercises, as recommended by your doctor or physical therapist, to help you return to your usual level of activity. Core stabilization exercises can help you strengthen the muscles of your trunk to protect your back.

Herniated Disc Surgery

Herniated disc surgery is generally considered only as a last resort and the eventually the treatment for about 10% of people who have a herniated disc. A good choice for people who have nerve damage that is getting worse, or severe weakness or numbness.  The most common and effective herniated disc surgery is Discectomy in which disc material is removed through an incision. 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. Discectomy can relieve leg symptoms such as pain and numbness, but it does not relieve back pain.

New Technologies now have patients having same day surgery and returning home without a stay in the hospital – often people are able to resume work and daily activities soon after surgery and are recommend a rehabilitation program including physical therapy and home exercises.

Read more about disc herniation here on Wikipedia.

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