herniated disc

What is a herniated disc?



The spine is made up of a series of connected bones called "vertebrae." The disc is a combination of strong connective tissues which hold one vertebra to the next and acts as a cushion between the vertebrae. The disc is made of a tough outer layer called the "annulus fibrosus" and a gel-like center called the "nucleus pulposus." As you get older, the center of the disc may start to lose water content, making the disc less effective as a cushion. This may cause a displacement of the disc’s center (called a herniated or ruptured disc) through a crack in the outer layer. Most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist.
A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling or weakness of the leg called "sciatica." Sciatica affects about 1-2% of all people, usually between the ages of 30 and 50.
A herniated lumbar disc may also cause back pain, although back pain alone (without leg pain) can have many causes other than a herniated disc












A herniated disc can affect how you're able to perform everyday tasks and can cause severe pain that influences almost everything you do. You and your doctor will make decisions about how to best treat your herniated disk (herniated disc), sometimes also called herniated disc, ruptured disc or slipped disc.
No single treatment choice is best for everyone. Your decisions will be based on a number of factors, including:
The nature of your condition
The degree to which it's affecting your lifestyle
The level of pain you're experiencing

What are the symptoms of a herniated disc?

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. Common symptoms of a herniated disc include:

Electric Shock PainPressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms, when the compression is in the lumbar (low back) region, the shocks go down your legs.

Tingling & Numbness


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.



Muscle Weakness


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 Problems


These 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 your should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.



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 your brain out to your extremities and back to the brain, all of these symptoms can be caused by a herniated disc pressing against the nerves.
How is the diagnosis of a herniated disc made?

How is the diagnosis of a herniated disc made?

Most often, your physician can make the diagnosis of a herniated disc by physical examination. By testing sensation, muscle strength, and reflexes, your physician can often establish the diagnosis of a herniated disc.
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.
Making the diagnosis of a herniated disc, and coming up with a treatment plan depends on the symptoms experienced by the patient, the physical examination findings, and the x-ray and MRI results. Only once this information is put together can a reasonable treatment plan be considered.

Herniated Disc - Treatment Overview

The goals of treatment for a herniated disc are to:
Relieve pain, weakness, or numbness in the leg and lower back caused by pressure on a spinal nerve root or the spinal cord.
Promote a return to normal work, recreation, and other activities.
Prevent reinjury to your back and reduce the risk of disability from back pain.

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.

1 Only 10% of people with herniated disc problems that cause noticeable symptoms eventually have surgery.2 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 surgery is considered.

Nonsurgical treatment
Nonsurgical 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. However, you can use medicine to control pain and inflammation. Pain medicines include:
Nonprescription and prescription pain relievers, such as acetaminophen (Tylenol) or 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:

Removing the Herniation With a Decompression
If a course of conservative treatments is not effective for relieving pain from a herniated disc, lumbar decompression surgery may be considered as an option. A microdiscectomy (or microdecompression) is a type of lumbar decompression surgery that is minimally invasive, and often provides great relief. During the procedure, the herniated portion of the disc under the nerve root is removed, giving the nerve root room to heal.