A herniated disc is a medical condition affecting your spine. It can be caused by trauma, from lifting injuries or from degenerative disc disease.
The vertebrae or bones that form your spine are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine, keeping it flexible. When a disc is damaged, however, it may bulge or break open, creating a herniation. Most herniated discs affect your lumbar spine or lower back, although you can get a herniated disc in any part of your spine, including your neck and upper back.
Minor herniations heal within a few weeks. Anti-inflammatory treatments effectively treat the pain associated with a herniated disc. Severe herniations do not heal on their own and may require surgery. This condition is referred to as a “slipped disc,” which is not medically accurate as spinal discs are fixed in position and cannot really “slip.”
Herniated Disc Symptoms
The symptoms of a herniated disc can vary depending on its location and the soft tissue involved. You may feel little or no pain if the disc is the only tissue injured.
If you suffer a major disc herniation, however, you can have severe, unrelenting neck or low back pain that radiates out to a limb. This happens because the herniated material irritates or impinges a nerve root. See the illustration. If the herniated disc is in your lumbar spine, you may experience sciatica because the nerve root of a sciatic nerve is involved. Sciatica is the most common symptom of a herniated disc in the lower back.
Other herniated disc symptoms may include sensory changes — numbness, tingling, muscular weakness, paralysis, paresthesia or burning, and affected reflexes. Unlike the pulsating pain caused by muscle spasms, pain from a herniated disc usually is continuous, at least in the affected position of your body.
Because of the range of symptoms, herniated discs often are not diagnosed right away. If you come in with undefined pain in your thigh, knee or foot, for example, your doctor has to run tests to find the cause. A herniated disc isn’t always the first thing on the list to check.
Typically, you experience symptoms on only one side of your body. If the herniation is very large, it can press on your spinal cord or on the bundle of nerves in your lumbar spine called the cauda equina. This serious condition affects both sides of your body and can cause permanent nerve damage or even paralysis. The nerve damage can result in loss of bowel and bladder control, as well as sexual dysfunction. If you have these symptoms, seek medical care right away.
Causes of Disc Herniations
Wear and tear: You can suffer a herniated disc from simple wear and tear of the disc. As you get older, your discs dry out and aren’t as flexible as they once were.
Injury to your spine: An accident or physical trauma can force the gelatinous material inside a disc through tears or cracks in the outer wall of the disc. Such an injury can cause the disc to bulge, break open, or break into pieces.
Lifting the wrong way: Major herniations usually happen at jobs that require lifting. Traumatic injury to your lumbar discs can occur if you lift something while bent at the waist, rather than lifting with your legs and a straight back. Minor back pain and chronic back tiredness indicate general wear and tear that can make you more susceptible to a herniated disc during more routine events like bending to pick up a pen.
Bending forward: When you sit or bend forward, you compress the anterior or stomach-side of your spine, stretching the posterior or back-side. Over time, the posterior membrane of your discs become stretched and thinned while the contents of the disc, the jelly-like nucleus, push against it. If the disc herniates, the nucleus breaks through the membrane and spills into your spinal canal. There it presses against your spinal nerves, producing intense and usually debilitating pain and other symptoms.
Diagnosing a Herniated Disc
Your Charleston back doctor makes a diagnosis based on your medical history, your symptoms and a physical examination. To find the root cause of your symptoms, you may have to undergo tests to confirm or rule out other causes, such as spondylolisthesis, degenerative disc disease, tumors, metastases and space-occupying lesions. The tests also can help your doctor evaluate how effective potential herniated disc treatment options may be.
Imaging tools help your physician form a diagnosis:
X-rays: Although traditional X-ray technology is limited in its ability to reveal soft tissues such as discs, muscles and nerves, it still can confirm or exclude possibilities such as tumors, infections and fractures. X-rays are a relatively inexpensive way to confirm the suspicion of a herniated disc. Once other possibilities are ruled out, your doctor can turn to other methods to provide final confirmation.
Computed Tomography scan: A CT or CAT scan shows the shape and size of your spinal canal, its contents, and the structures around it, including soft tissues. Visual confirmation of a herniated disc, however, can be difficult with a CT scan.
Myelogram: This test produces an X-ray of your spinal canal after an injection of a contrast dye into the surrounding spaces. By revealing displacement of the contrast dye, a myelogram can reveal structures such as herniated discs, tumors or bone spurs that are putting pressure on your spinal cord or nerves. Because this process involves injecting a foreign substance near your spine, most doctors prefer using an MRI scan, but myelograms still can provide excellent outlines of space-occupying lesions, especially when combined with a CT scan.
Magnetic Resonance Imaging (MRI): An MRI produces three-dimensional images of body structures using powerful magnets and computer technology. It shows the spinal cord, nerve roots, and surrounding areas. An MRI shows soft tissues — including tumors and discs that are enlarged or degenerated — better than a CAT scan. An MRI often produces the most conclusive evidence for the diagnosis of a herniated disc. T1-weighted images provide clear proof of protruded disc material in the spinal canal.
Electromyogram and Nerve Conduction Studies: EMG and NCS tests measure the electrical impulses along nerve roots, peripheral nerves, and muscle tissue. EMG/NCS can reveal ongoing nerve damage, indicate additional nerve compression or show if nerves are healing from a past injury. EMG/NCS tests are typically used to pinpoint the source of your nerve dysfunction without disturbing your spine.
Herniated Disc Treatment
Most herniated discs heal themselves in about six weeks and do not require surgery. Initial treatment for a herniated disc usually consists of non-steroidal anti-inflammatory pain medication. The back doctors at the Southeastern Spine Institute (SSI) employ a conservative approach to addressing all back pain.
In some cases, cortisone is injected into your spine adjacent to the suspected cause of the pain, a technique known as epidural steroid injection. These injections may result in some improvement in the pain associated with a herniated disc after two to six weeks. Ancillary approaches — such as rehabilitation, physical therapy, anti-depressants, and in particular, graduated exercise programs — are useful adjuncts to anti-inflammatory approaches.
Because inflammation usually fades over time, about half of all people with a herniated disc in the low back recover within one month. Most people recover within six months. Only 10 percent of people with noticeable symptoms eventually have surgery.
When a herniated disc heals on its own, your body breaks down and absorbs the jellylike nucleus inside the disc, a process called resorption. For this reason, the conservative physicians at SSI typically recommend non-surgical treatment before even considering herniated disc surgery.
Non-Surgical Herniated Disc Treatment
Non-surgical herniated disc treatment is intended to help you return to your daily activities. Non-surgical options include:
Education. Learn how to take care of your back, which may include training in pain and symptom control. If your doctor recommends physical therapy, your physical therapist can provide treatment with physical or mechanical means — such as 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. Medicine to control pain and inflammation is available, including:
- Non-prescription and prescription pain relievers
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Muscle relaxants
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 generally is considered a last resort. Only about 10 percent of sufferers eventually undergo surgery. It may be the only effective treatment for people who have nerve damage that is worsening or have severe weakness or numbness.
The most common and effective herniated disc surgery is a discectomy in which your spine surgeon removes disc material through an incision. A discectomy can relieve leg symptoms such as pain and numbness, but it does not relieve back pain, so it is not for everyone.
New technologies such as endoscopic or minimally invasive surgery now permit our surgeons to perform same day surgery, so you can have the operation and return home without a stay in the hospital. Because we recommend a rehabilitation program that includes physical therapy and home exercises, you often can resume work and your daily activities soon after the surgery.
Contact us today to learn more about the condition and treatment of your herniated disc.