Definition and Causes

A herniated disc is a protrusion of the intervertebral disc that presses against the spine nerves. In case of disc herniation, the disk may move out of place (INTACT) or break open (RUPTURE). A tear in the outer part of a disc allows the jelly-like content of the disc to protrude beyond the support of the adjacent vertebrae. The leaking disc then presses against (pinches) the nerves in the spinal canal, thus producing pain which is usually radicular, usually starting in the back and radiating to the legs (lower back (Lumbar) disc herniation) , or starting in the neck and radiating to the arms (upper back and neck (Cervical) disc herniation). Lumbar disc herniation is more frequent than Cervical disc herniation.

As people age, their discs dry out and become less flexible. This is why disc herniation occurs more frequently in middle-aged and older people, especially those who have been involved in strenuous physical activities. Disc herniation can also be caused by trauma such as a car accident. Other causes of disc herniation include congenital conditions that affect the size of the spinal canal and other idiopathic (unknown) causes.

Symptoms

Symptoms of disc herniation typically are experienced on one side of the body. The disc that presses against the spine nerves produces a radiating pain, burning sensation – usually feeling like electric shock pains - or numbness along the affected nerve path. This pain can vary depending on the location of the herniation and the direction of the protrusion. The pain usually ranges from minor and tolerable to extreme and debilitating. However, in few cases it is possible to have disc herniation without any noticeable symptoms. 

When the nerve compression is in the upper back (Cervical) area, pain shoots down the arms. While compression in the lower back (Lumbar) region, leads to pain extending from the buttocks and traveling down the leg (Sciatica). 

Further, when compression is in the Thoracic area, pain wraps around the chest. This condition also causes muscle weakness in arms and legs. In severe cases in which the Cauda Equine (a bundle of nerves and nerve roots in the lower spine) is being compressed, a herniated disc may result in loss of bladder or bowel control, decreased sexual performance (Herniation in L3 to L5 disc levels), and even paralysis.

Diagnosis

Like all other spinal diseases, the primary diagnosis of disc herniation consists of reviewing the patient's medical history and a physical examination including nerve function in certain parts of legs or arms, assessing muscle strength and motion. The next step is reviewing diagnostic tests such as MRI scans and CT scans to confirm the condition and gain other necessary information such as the exact location of the herniation.

Treatment

Based upon the diagnosis there are different treatments for disc herniation. 

In most cases, nonsurgical treatments such as resting, taking pain relievers and anti-inflammatory medications may relieve symptoms. Epidural steroid shots are another commonly prescribed treatment.

However, if the pain continues for more than 3 months and when nonsurgical treatments do not provided adequate pain relief, surgical intervention is required. The most common surgical procedure to treat disc herniation at the Bonati Spine Institute is Discectomy. 

In this procedure, the portion of the disc that is causing nerve compression is removed, relieving the nerve compression and allowing the nerve to recover. With the patient awake (only local anesthesia), a small incision is made on the patient’s back and the endoscopic tube is inserted. Using specially adapted endoscopic instruments, the diseased disc material is removed and a laser vaporizes the surrounding problem tissue. A laser is then used to shrink and reshape the remaining disc. 

This procedure, pioneered by Dr. Alfred O. Bonati at the Bonati Spine Institute since 1991 (FDA) reduces tissue, muscle and bone trauma; minimizing infection risks and facilitates faster recovery time from traditional open wound surgery.