Herniated Disc

Many people suffer from neck pain, back pain, leg pain, or weakness of the muscles in the extremities due to a herniated disc. Disc herniation mostly takes place in the lower area of the spine (lumbar spine). Lumbar disc herniation occurs 15 times more often than cervical (neck) disc herniation, and it is one of the most common causes of sciatica or lower back pain.

Overview

A herniated disc occurs when one of the discs located between the vertebrae in the spine gets damaged. These discs act as shock absorbers and keep the vertebrae from rubbing painfully against each other. There are several terms used to describe disc pathology, including herniated disc, bulging disc, and pinched nerve.

Their symptoms are often similar. Medical professionals and healthcare practitioners do not always agree on their definitions, which can frustrate patients trying to get a medical diagnosis. Adding to the confusion are an unusually wide range of terms also used to describe spinal disc problems, including ruptured disc, slipped disc, torn disc, collapsed disc, disc disease, disc protrusion, and black disc.

Anatomy

The spine consists of 33 vertebrae stacked on top of each other to form the spinal column. The spinal column supports the body and allows you to stand upright, bend, and twist without injuring the spine. The spinal disc is a soft cushion that sits between each vertebra of the spine. The discs consist of an outer ring, the annulus, which has crisscrossing fibrous bands that attach to bodies of each vertebra. Inside each disc is a gel-filled center, called the nucleus pulposus.

The discs function like coiled springs. The crisscrossing configuration of the fibers of the annulus pull the vertebrae together to be cushioned by the elastic resistance of the nucleus. The nucleus allows the vertebrae to roll over the incompressible gel.

What is a Herniated Disc?

The discs become less elastic with age and more vulnerable to injury. As the discs become less elastic, they can rupture due to stress on the body.

When a disc ruptures, a portion of the spinal disc pushes outside its normal boundary. This is called a herniated disc. When a disc bulges out from between the vertebrae, it constricts the spinal nerves that are located very close to the disc. Therefore, the spinal nerves and spinal cord can become compressed causing pain, numbness, weakness and other symptoms.

There is normally enough extra space around the spinal cord and spinal nerves, but if too much of the herniated disc is bulging, these structures may be compressed. When you have a symptomatic herniated disc, it is the not the disc itself that is painful, but the pain caused by the disc compressing the nerve that causes you to feel pain. A herniated disc is also often referred to as a slipped disc.

herniated disc

Lumbar Herniated Disc

Lumbar herniated discs are a common problem in healthcare. They most often affect people aged 35-50. While a lumbar herniated disc is painful, the symptoms do not usually last long. Approximately 90% of patients diagnosed with a lumbar herniated disc have no symptoms after 6 weeks, even if they do not seek treatment.

It is not unusual to have a lumbar disc herniation and have no symptoms. The symptoms may be triggered by moving or lifting something heavy and/or twisting the lower back.

Rarely, a lumbar herniated disc can cause cauda equina syndrome, which is caused by compression of the cauda equina (a bundle of nerve roots at the bottom of spinal cord). Cauda equine is a serious condition that should be treated immediately. If cauda equina syndrome is not treated quickly, it may result in neurological and physical problems such as paralysis, impaired bowel or bladder control, and difficulty walking.

Symptoms of Lumbar Herniated Discs

Herniated discs occur most often in the lumbar spine. They commonly inflame or press against a nearby nerve and cause pain to radiate along the length of the nerve. This is the most common cause of sciatica, pain that radiates down the leg along the sciatic nerve. Symptoms of lumbar herniated discs include:

Leg pain: although the herniated disc is in the back, the leg pain is usually worse than the back pain. Pain that radiates down the back of the leg is generally called lumbar radiculopathy or sciatica.

Nerve pain: sharp, shearing, electric, piecing or radicular pain is the most common symptom described for a herniated disc.

Variable location of symptoms: depending on the degree of the herniation and where the disc herniates, patients may experience symptoms in the low back, buttock, back or front of the thigh, the calf, foot and/or toes. The symptoms generally affect only one side of the body.

Neurological symptoms: tingling, numbness, pins-and-needles, and weakness in the leg, foot, and/or toes.

Foot drop: patients may experience difficulty lifting the foot when standing or walking on the ball of the foot.

Cervical Herniated Disc

Although a cervical herniated disc can be caused by a neck injury, the symptoms usually start spontaneously. A cervical herniated disc can cause pain, numbness and/or tingling as the disc material presses on a cervical nerve. The cervical discs are not as large as other discs in the spine, however, there is also not as much room for the nerves. This means a small cervical herniated disc can cause severe pain. This pain may get worse with coughing, straining or laughing.

Whiplash due to an auto accident is a common cause of a herniated disc in the neck. Bad posture is another common contributing factor to the problems in the cervical spine, including a herniated disc. By the excessive use of smartphones these days, cervical problems have been rising. Smartphone users spend hours with their heads dropped down. This puts excessive stress and strain on the neck, which can cause many problems in the cervical spine.

Symptoms of Cervical Herniated Discs

When a herniated disc occurs in the cervical region, these symptoms are possible:

Shoulder pain: deep pain near or over the shoulder blades on the affected side.

Neck pain: pain in the neck, especially in the back and sides, is a common symptom of a herniated disc in the cervical spine. Spasm of the neck muscles may happen.

Arm pain: a herniated disc in the cervical spine may cause radiating pain that shoots down the arms, causing pain, muscle weakness and tingling in the arms.

Variable location of symptoms: the symptoms of a cervical herniated disc depend on where the disc is herniated, and depending on the location, patients may experience pain in their shoulder, arms, hands, fingers and even chest. The symptoms generally affect only one side of the body.

Neurological symptoms: tingling, numbness, pins-and-needles, and weakness in the arm, hand, and/or fingers.

Thoracic Herniated Disc

The most common symptom of a thoracic herniated disc is pain that is either isolated to the upper back or radiating down a single nerve root. The pain is usually worse when coughing or sneezing.

The radicular pain is sometimes perceived to be in the belly or chest, which can confuse the medical diagnosis and lead to an assessment for heart, lungs, kidneys, and gastrointestinal disorders as well as non-spine musculoskeletal causes. There are also disorders of the spine itself that have similar symptoms, including spine fracture, tumor, infection, and certain metabolic disorders.

A thoracic herniated disc can also be present with myelopathy (spinal cord dysfunction) if it has herniated in the spinal cord area. These symptoms include difficulties with walking and balancing, numbness below the area of compression, weakness in the lower extremities, and bladder or bowel dysfunction.

The symptoms of a thoracic herniated disc generally correlate with the location and size of the herniation. The herniated disc may protrude centrally, laterally, or centro-laterally (back and to the side).

Causes of Herniated Discs

Most herniated discs are the result of gradual age-related wear and tear on the spine, called disc degeneration. Spinal discs lose some of their water content due to age. That makes them less resilient and more likely to tear or rupture.

Most patients can’t pin down exactly what caused their herniated disc. Some causes include using your back muscle instead of your leg muscles when lifting heavy objects, twisting or turning while lifting, and, rarely, a traumatic event such as a blow to the back or a fall.



Diagnosing Herniated Discs

Diagnosis for a herniated disc begins with a physical examination and detailed medical history taken by a doctor. The doctor will ask about the type of pain, other medical conditions, such as osteoporosis, osteoarthritis, spinal arthritis, your work and home life, and your family’s medical history.

The physician will also perform neurological and range of motion tests, check your vital signs, monitor your gait, and examine your spine. Imaging tests may be ordered if the doctor sees signs of a more serious problem.

Risk Factors

While the pain associated with a herniated disc may seem sudden, it is generally the result of a gradual process. Spinal discs have high water content that helps them stay flexible. They begin to dry out as part of the normal aging process and lose their ability to effectively cushion the vertebrae. The discs’ strong outer layer becomes brittle and can crack and tear from even minor movements. Risk factors for herniated discs include:

Age: most herniated discs occur between 35-50 years of age.

Gender: men are more than twice as likely to herniate a disc.

Physical work: jobs that entail lifting heavy loads as well as repetitive pulling, pushing, and twisting.

Obesity: carrying excess weight increases stress on the spine and a herniated disc is 12 times more likely.

Smoking: nicotine speeds up degeneration because it limits blood flow to the discs and hampers healing.

Family medical history: heredity is a factor in disc degeneration, and therefore in disc herniation caused by degeneration.

Examination and Tests

During the first visit to a doctor for a possible disc herniation, you will be asked detailed questions about your medical history and undergo a complete physical examination. The doctor will ask about the intensity and duration of the pain, previous injuries or illnesses, back surgeries or procedures, whether or not you smoke, your work environment, and leisure activities. You will also be asked about other conditions that might be a cause of their symptoms. In addition, the doctor may order imaging tests such as:

MRI (magnetic resonance imaging) to determine where the herniation has occurred.

CT scan (computed tomography) is sometimes used in place of an MRI if there is a reason that an MRI is not advised.

X-rays are used to rule out issues such as broken bones, bone abnormalities, tumor, infection, or alignment problems of the spine.

CT myelogram is similar to a CT scan but it uses dye in the spinal fluid with x-rays to view the dye. This can give the doctor a detailed view of the location and size of the herniation.

Electromyography may be used to pinpoint the exact nerve that is impacted.

Treatment for Herniated Discs

Treatment for herniated discs depends on the level of your pain or discomfort. Conservative treatment consisting of avoiding positions that cause you pain and following a pain medication regimen and exercise program can relieve symptoms in most people.

Non-Surgical Treatment

Non-surgical treatment includes one or more of the following: strengthening exercises or stretching, pain medication, and physical therapy. A physical therapist will give you exercises to strengthen your muscles and positions that can minimize the pain. Medications used to treat herniated discs may include:

Over-the-counter (OTC) pain medications such as ibuprofen (Motrin IB, Advil) or naproxen (Aleve) for mild to moderate pain.

Anticonvulsants (gabapentin, pregabalin) to treat radiating nerve pain.

Muscle relaxants such as duloxetine (Cymbalta) may be prescribed if you have muscle spasms.

Antidepressants (amitriptyline) to reduce pain and restore normal sleep patterns.

Cortisone injections to reduce inflammation directly in the area of nerve root pain and around the spinal nerves.

Narcotics or opioids such as an oxycodone-acetaminophen combination (OxyContin, Percocet) or codeine may be prescribed for a short period of time to relieve pain that doesn’t improve with OTC drugs. It must be noted that, there is no solid evidence that opioids, or narcotics, work better than non-narcotic pain medications in relieving chronic pain from a spine condition. There are a number of serious risks with opioids that need to be considered. Opioids can be habit-forming if the patient isn’t careful. Opioids can also have limited effectiveness if the patient develops a tolerance to the medication over time.

Surgical Treatment

If non-surgical treatments such as exercise, physical therapy, and medications do not relieve your pain, surgery may be necessary. The Bonati Spine Institute has been a leader in advanced spine surgery for decades, with more than 55,000 successful surgical procedures performed.

The Bonati Spine Procedures achieve a very high success rate in the surgical treatment of herniated discs. The physicians at The Bonati Spine Institute may perform an array of procedures for treating herniated discs including:

Discectomy for a Herniated Disc

A discectomy is a surgical procedure performed to remove a portion of the bulged or herniated disc, thereby relieving pressure on the impacted spinal nerves or spinal cord. The Bonati Discectomy is performed using local anesthesia and Conscious IV Sedation, allowing the patient to be comfortable and responsive during the procedure.

Foraminotomy for a Herniated Disc

A foraminotomy is a decompression surgery performed in order to increase the space of the foramen and hollow out the passageway where the nerve roots exit the spinal canal. The procedure involves the removal of bone or tissue that obstructs the neuroforamen and compresses the nerve roots leading to inflammation and radiating pain. The removal of part of the lamina is often necessary for the surgeon to gain access to the affected nerve roots in the neuroforamen.

Laminectomy/ Laminotomy for a Herniated Disc

A laminectomy/laminotomy is a surgical procedure performed to treat a herniated disc. The surgery is designed to relieve pressure on (decompress) the spinal cord or spinal nerve roots through the widening of the spinal canal. The procedure is carried out by removing or trimming part of the lamina (roof) of the vertebrae in the compressed area. The removal of part of the lamina creates an opening for the compressed nerves, relieving pressure on the nerve roots and reducing inflammation. The partial removal of the lamina may also allow the surgeon to remove any bone spurs or damaged tissue causing pain and inflammation in the patient.. Laminectomy and laminotomy are often utilized in order to give the surgeon the proper space to perform the foraminotomy.

Prevention & Self-Care

Although the chance that you will suffer from a herniated disc increases with the normal aging of the spine, there are some actions you can take to prevent a herniated disc.

Quit smoking

Eat well and maintain a healthy weight

Maintain good posture

Lift and bend properly

Reduce alcohol consumption

Other lifestyle modifications, like changing your daily work routine if you’re repeatedly exposed to significant back stress, may also help as can maintaining proper posture.

The Bonati Spine Institute’s treatment for a herniated disc can effectively return you to a normal lifestyle sooner than other surgical alternatives. We advocate patients suffering from herniated discs to contact us to request a no-obligation MRI review or discussion with one of our spine surgeons to see if you are a candidate for the Bonati Spine Procedures. Find out why The Bonati Procedures are considered to be among the world’s best solutions when it comes to spine surgery.