Herniated Disc Center
What Is a Herniated Disc? Herniation of the nucleus pulposus occurs when the nucleus pulposus (gel-like inner substance) breaks through the anulus fibrosus (tire-like outer structure) of an intervertebral disc (spinal shock absorber). See the image below to see these parts of the intervertebral disc pointed out.
Your back, or spine, is made up of many parts. Your backbone, also called your vertebral column, provides support and protection. It consists of 33 vertebrae (bones). The intervertebral discs are between each of the vertebra. Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit to various parts of the body.
Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are strands of tissues that act as the source of power for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together, and tendons connect muscles to bones and discs. Blood vessels provide nourishment. These parts all work together to help you move about.
A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body's weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.
The progression to an actual herniated disc varies from slow to sudden onset of symptoms. There are 4 stages:
- disc protrusion
- prolapsed disc
- disc extrusion
- sequestered disc
Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete disc herniations. Pain resulting from a herniated disc may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (ie, tingling, numbness) and/or motor changes (ie, weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.
Progression of Herniated Disc
The extremities affected are dependent upon the vertebral level at which the herniated disc occurred. Consider the following examples:
- Cervical: Pain in the neck, shoulders, and arms
- Thoracic: Pain radiates into the chest
- Lumbar: Pain extends into the buttocks, thighs, legs
Cauda Equina Syndrome occurs from a central disc herniation and is serious, requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter.
The spine is examined with the patient laying down and standing. Due to muscle spasm, a loss of normal spinal curvature may be noted. Radicular pain may increase when pressure is applied to the affected spinal level.
A Lasegue test, also known as Straight-leg Raising Test, is performed. The patient lies down, the knee is extended, and the hip is flexed. If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed.
Other neurological tests are performed to determine loss of sensation and/or motor function. Abnormal reflexes are noted as these changes may indicate the location of the herniation.
Radiographs (x-rays) are helpful, but computed axial tomography (CT) or magnetic resonance imaging (MRI) provides more detail. The MRI is the best method and enables the physician to see the soft spinal tissues unseen in a conventional x-ray.
Radiographic Evidence of HNP
The findings from the examination and tests are compared to make a proper diagnosis. This includes determining the location of the herniation so treatment options can be reviewed with the patient.
What is a herniated disc?
In between your vertebrae in your spine, you have intervertebral discs. They help cushion your movements. The disc has a gel-like inner substance called the nucleus pulposus and a tire-like outer band called the annulus fibrosus. The nucleus can push out through the annulus: That's a herniated disc.
What causes a herniated disc?
Herniated discs can develop gradually as the result of wear and tear on the spine—a natural part of aging. As we grow older, our intervertebral discs can lose their elasticity and water content, making them more likely to herniate. Over several weeks or even months, the nucleus pulposus can start to push through the annulus fibrosus.
Herniated discs can also happen suddenly from incorrect lifting or twisting that aggravates a weakened disc.
What are some non-surgical ways to deal with a herniated disc?
To help deal with pain from herniated disc, you can try:
- ice during the first 24 to 48 hours after the initial injury (if you herniate your disc suddenly); the ice will help reduce the swelling, muscle spasms, and pain. Wrap the ice in a towel and put it on the painful area for 15 minutes at a time.
- heat after the first 48 hours because that will warm and relax sore tissues; you can use a heating pad for 20 minutes at a time.
- restricting your activities that increase the pain
- light exercise (walking, swimming, etc) as recommended by your doctor
- over-the-counter medications
- prescription medications
- physical therapy
Will I need surgery?
Most herniated discs respond well to non-surgical treatments. In fact, sometimes the pain from herniated discs goes away on its own after 4 to 6 weeks. Surgery should be considered only after you've tried several months of non-surgical treatment. You surgeon will recommend the best kind of surgery for you. Here are some common kinds of surgery used for patients with a herniated disc:
- anterior cervical discectomy and fusion
To learn more about these specific surgeries, please read Surgery for a Herniated Disc.