Round discs with a pillow-like interior and an outer layer cushion the bones that form the spine. The outer layer is called the annulus and surrounds the nucleus. The discs are positioned between each vertebra in the spinal cord. The discs absorb shock for the bones of the spine. A herniated disc is a part of the nucleus of the disc that is pushed out of the annulus and inter the spinal canal. The disc nucleus enters the spinal canal through a tear in the annulus. Herniated discs are also referred to as bulged discs, slipped discs, ruptured discs. There is limited space in the spinal canal which does not have room for the spinal nerve and herniated disc. Because of the limited room, the spinal nerves can be pressed by the disc leading to pain. Herniated discs may happen anywhere along the spinal cord but are commonly seen in the lower back. The lower back is referred to as the lumbar spine. Herniated discs also often happen in the neck. The neck is referred to as the cervical spine. Depending on the placement of the herniated disc, the area pain is experienced will vary.
CAUSES
A herniated disc can be caused by a strain, an injury, but disc material can also degrade over time. When a disc degrades over the, the ligaments around the disc start to get weaker. As the disc degenerates, even a small strain, injury, or twisting motion can lead to a ruptured disc. Some people are more prone to herniated discs than others and can also suffer from multiple herniated discs at a time. Some families are also more prone to have a herniated disc.
SYMPTOMS
Size of herniated and position of herniated disc can vary so symptoms may also vary. The pain will differ whether or not the herniated disc is pressing on a nerve. If it is not pressing on a nerve, there can be minimal backaches to no pain. If the herniated disc presses on a nerve, a patient can experience pain, numbness, or weakness in the parts of the body that the affected nerve travels. Often, a herniated disc is known to cause lower back pain or long term, occasional episodes of lower back pain.
Lumbar spine (lower back): A herniated disc in the low back can lead to sciatica or radiculopathy. Pressure at or near the sciatic nerve may lead to pain, tingling, burning, and numbness that shoots from the buttocks to the leg and occasionally down to the foot. Typically only one side of the body will feel this pain. The pain can feel like shock and can be sharp. The pain may escalate with movement or sitting. The pain may escalate by straightening the leg experiencing pain. Lower back pain may be experienced as well. Acute sciatica can cause more pain in the legs compared to the pain in the low back.
Cervical spine (neck): A compressed serve in the back can cause cervical radiculopathy. This results in pain that may be dull or sharp in the neck or shoulder blades that travels down the arm to the hand or fingers. The pain experienced may escalate with neck movement.
SEEKING CARE
Few people need surgery due to a herniated disc and symptoms may subside over time. Limit activities for a couple of days. Bedrest is not encouraged and walking is good as long as it is not painful. An anti-inflammatory such as ibuprofen may be taken. A primary care evaluation will often recommend physical therapy. Unless symptoms have been present for more than 6 weeks, an MRI is not recommended. If the symptoms are lasting for four weeks or more, one can consult with a neurosurgeon or a spine specialist. Get an immediate evaluation if the symptoms include weakening in the arms and legs, sensation loss in genital or rectal areas, loss of control of urine or stool, a history of metastatic cancer, infection, or fever and radiculopathy or an accident that caused pain. If there are ongoing neurological deficits, imaging may be recommended earlier.
TESTING
The MRI is a common test for herniated discs. X-rays, CT scans, myelogram, electromyogram and nerve conduction studies may also be used.
TREATMENT
Nonsurgical treatment
A patient may be recommended to lay low for a couple of days or weeks to decrease inflammation of the spine. Bed rest, though, is not recommended. If the pain experienced is mild, nonsteroidal anti-inflammatory medicine may be used. Using a spinal needle and X-ray guidance, an epidural steroid injection could be performed. Physical therapy is also often recommended.
Surgery
If a nonsurgical treatment plan did not improve a patient's condition, surgery could be recommended. Many patients with herniated discs have reported major pain relief after surgery but there is no promise surgery will help. Possible applicants for surgery are considered when radicular pain degrades quality of life, there are worsening neurological deficits developing, normal bladder and bowel function is gone, nonsurgical approaches are ineffective, the patient is in good health.
Lumbar spine surgery
A Lumbar Laminotomy is a procedure done to reduce leg pain or sciatica due to a herniated disc. Over the herniated disc, a small incision will be made down the center of the back. During surgery, part of the lamina could be removed. After an incision has been made through the skin, muscles are moved to the side to create a clear view for the surgeon of the vertebrae. To get access to the herniated disc, a small opening will be made between the two vertebrae. The disc will be removed through a discectomy. Then, the spine may need to be stabilized. Along with a laminotomy, a spinal fusion may be performed.
During an artificial disc surgery, the damaged disc is removed and replaced through a small incision in the abdomen. Few people are apple to get an artificial disc surgery. To get this surgery, a patient must have disc degeneration in only one disc, between L4 and L5, or L5 and S1. The patient should have already tried a nonsurgical approach for six months without experiencing any improvements. A patient should have no infections, osteoporosis, or arthritis, and must be in good health. A patient will not be a candidate for artificial disc surgery if there is multiple affected discs or immense leg pain.
Cervical spine surgery
Depending on the location of the herniated disc and the preference of the surgeon, an operation could be performed from the front of the neck or the back of the neck. Through a laminotomy, part of the lamina may be removed. Then, the disc will be removed when using the posterior approach through the back of the neck. When getting the posterior surgery, the patient often does not need a surgical fusion. During the anterior surgery, once the disc is taken out, the spine will be stabilized using a cervical plate. A cervical plate is an interbody device and screws. For certain applicants, artificial cervical discs may be used instead of fusion.
