Terms like degenerative disc disease, facet hypertrophy, spondylosis, bone spur, and stenosis are often mentioned in the findings of the test performed.
But, the terms most often mentioned are herniated or bulging disc, which, as one might expect, instills the fear of surgery in the patient. Now, while spinal surgery is always the last resort in the treatment of back or neck pain, the “herniated disc” label makes a patient less confident in their ability to maintain a normal life.
The purpose of this article from Medical News Today is to share information regarding disc herniation that will, hopefully, mitigate fears of lifelong disability.
What Is A Herniated Disc?
Your spinal column is made up of vertebrae separated by cartilage-like disks that act as cushions and shock absorbers for your back. When an injury or a degenerative disease causes the disk to weaken or tear, the center of the disk pops out and compresses the spinal nerve. The pinched spinal nerve causes pain.
According to Medilexicon’s medical dictionary:
A herniated disk is a protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen with potential compression of a nerve root or into the spinal canal with potential compression of the cauda equina in the lumbar region or the spinal cord at higher levels characterized by disruption of the annular fibrosis.
Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation. The former is the most common, causing lower back pain, or lumbago, and often leg pain as well, in which case it is commonly referred to as sciatica.
Lumbar disc herniation occurs 15 times more often than cervical disc herniation, and it is one of the most common causes of lower back pain. The cervical discs are affected 8% of the time and the upper-to-mid-back, or thoracic discs, only 1 to 2% of the time.
The following locations have no discs and are therefore exempt from the risk of disc herniation: the upper two cervical intervertebral spaces, the sacrum, and the coccyx.
Alternative terms for this condition include lumbar radiculopathy, cervical radiculopathy, herniated intervertebral disk, prolapsed intervertebral disk, slipped disk, ruptured disk and herniated nucleus pulposus.
What are the symptoms of a Herniated Disk?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
When the spinal cord or spinal nerves become compressed, they don’t work properly. This means that abnormal signals may get passed from the compressed nerves, or signals may not get passed at all.
Electric shock pain is defined as pressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical region, the shocks go down your arms, when the compression is in the lumbar region, the shocks go down the legs.
Patients often have abnormal sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful electric shock sensations.
Because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness. Nerve irritation can also be tested by examining reflexes.
Bowel or bladder symptoms are important because it may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency, and one should see a doctor immediately if one has problems urinating, having bowel movements, or if numbness around the genitals is felt.
All of these symptoms are due to the irritation of the nerve from the herniated disc. By interfering with the pathway by which signals are sent from the brain out to extremities and back to the brain, all of these symptoms can be caused by a herniated disc pressing against the nerves.
What are the causes of a Herniated Disk?
Disc herniations can result from general wear and tear, such as when performing jobs that require constant sitting. 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.
When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. The spinal vertebrae are separated by disks filled with a soft, gelatinous substance. These disks cushion the spinal column and space between the vertebrae. These disks may herniate or rupture from trauma or strain. When this happens, the spinal nerves may become compressed, resulting in pain, numbness, or weakness.
The lower back, or lumbar area of the spine is the most common area for a slipped disk. The cervical disks are affected 8% of the time. The upper-to-mid-back disks are rarely involved.
Disk herniation occurs more frequently in middle-aged and older men, especially those involved in strenuous physical activity. Other risk factors include any conditions present at birth (congenital) that affect the size of the lumbar spinal canal.
Diagnosing a Herniated Disk
A physical examination and history of pain may be all that a health care provider needs to diagnose a herniated disk. A neurological examination will evaluate muscle reflexes, sensation, and muscle strength. Often, examination of the spine will reveal a decrease in the spinal curvature in the affected area.
Leg pain that occurs when a person sits down on an exam table and lifts the leg straight up usually suggests a herniated lumbar disk.
A foraminal compression test of Spurling is done to diagnose cervical radiculopathy. For this test, one will bend the head forward and to the sides while the doctor puts slight downward pressure on the top of the head. Increased pain or numbness during this test is usually a sign of cervical radiculopathy. Radiculopathy refers to any disease that affects the spinal nerve roots. A herniated disk is one cause of radiculopathy, or sciatica.
An MRI is commonly used to aid in making the diagnosis of a herniated disc. It is very important that patients understand that the MRI is only useful when used in conjunction with examination findings. It is normal for a MRI of the lumbar spine to have abnormalities, especially as people age. Patients in their 20s may begin to have signs of disc wear, and this type of wear would be expected on MRIs of patients in their 40s and 50s. This is the reason that your physician may not be concerned with some MRI findings noted by the radiologist.
EMG may be done to determine the exact nerve root that is involved and a nerve conduction velocity test may also be done, and a Myelogram may be done to determine the size and location of disk herniation.
What are the treatment options for a Herniated Disk?
Non-surgical methods of treatment are usually attempted first, leaving surgery as a last resort. Pain medications are often prescribed as the first attempt to alleviate the acute pain and allow the patient to begin exercising and stretching.
Diet and exercise are crucial to improving back pain in overweight patients. Physical therapy is important for nearly everyone with disk disease. Therapists will tell a patient how to properly lift, dress, walk, and perform other activities. They will work on strengthening the muscles that help support the spine.
Ice and heat application can be extremely helpful in relieving the painful symptoms of a disc herniation. By helping to relax the muscles of the back, ice and heat applications can relieve muscle spasm and provide significant pain relief.
Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, and often help relieve the pain associated with a disc herniation. By reducing inflammation, these medications can relieve some pressure on the compressed nerves. NSAIDs should be used under doctor’s supervision.
Steroid injections into the back in the area of the herniated disk may help control pain for several months. Such injections reduce swelling around the disk and relieve many symptoms. Spinal injections are usually done on an outpatient basis, using x-ray or fluoroscopy to identify the area where the injection is needed.
Surgery should only be considered as a last resort after all conservative treatments have been tried, that did not alleviate the pain and heal the disc herniation.
Surgery is indicated if a patient has a significant neurological deficit. The presence of cauda equina syndrome, in which there is incontinence, weakness and genital numbness, is considered a medical emergency requiring immediate attention and possibly surgical decompression.
Preventing a Herniated Disk
Safe work and play practices, proper lifting techniques, and weight control may help prevent back injury in some people.
Some health care providers recommend the use of back braces to help support the spine. Such braces can help prevent injuries in people whose work requires them to lift heavy objects. However, overuse of these devices can weaken the abdominal and back muscles, making the problem worse.
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