Herniated Disc Center
A herniated disc occurs when the nucleus pulposus, the gel-like inner substance of an intervertebral disc, breaks through the annulus fibrosus, the tire-like outer structure. Pain is the most common symptom. However, nerve compression and inflammation can cause other symptoms including numbness, tingling and/or weakness.
Disc herniation can cause symptoms, including reflex dysfunction or loss in the arms or legs, depending on where the disc ruptures.
- Cervical Spine: Neck pain may radiate into the shoulders or arms
- Thoracic Spine: Mid-back disc herniation is uncommon. Pain may radiate into the front or back of the body's trunk
- Lumbar Spine: Low back pain may extend into the buttocks, thighs, and legs (eg, sciatica)
A herniated disc occurs most often in the lumbar region (lower back) of the spine, particularly at the L4-L5 and L5-S1 (L=lumbar, S=sacral) levels, since this region supports most of the body's weight.
Cauda Equina Syndrome
Near the first lumbar vertebra the spinal cord technically ends branching into a bundle of nerves. This bundle of nerves is similar to a horse's tail in appearance, and is therefore termed the cauda equina, it's meaning in Latin.
Cauda equina syndrome can be a serious complication of a central disc herniation. The word central indicates where the disc ruptures—that being into the spinal canal. A central disc herniation may compress nerves within the spinal canal. Symptoms may include bilateral leg pain, loss of sensation in the anus, paralysis of the bladder, and weakness of the anal sphincter. These types of symptoms require immediate medical attention.
Causes of Herniated Discs
Herniated discs usually develop gradually due to everyday wear and tear on the spine, and simply growing older. With aging, intervertebral discs are affected by degenerative changes in the body that cause discs to lose some elasticity and water content. Trauma (eg, fall) or lifting and twisting are examples of events that can cause a disc to suddenly herniate.
Herniated Disc Diagnosis
The diagnostic process includes the patient's medical history and thorough physical and neurological evaluation. Your spine is observed while standing and walking, as well as other movements to assess balance and range of motion. The doctor palplates (examines by touch) the spine and examines it for any abnormalities, such as spinal curvature. The neurological examination includes testing the reflexes, assessing any areas of weakness, and bilateral sensation. As part of the examination, the doctor focuses on the intensity an characteristics of the patient's pain and other symptoms.
Spinal imaging tests may be recommended, and the results can help confirm the diagnosis. An accurate diagnosis is essential to treatment planning. The doctor may order x-rays, CT scan, or MRI. CT scans and MRI utilize computer technology and provide detailed images of the spine.
Treatment for a Herniated Disc
Often, when a patient is referred to an orthopaedic spine surgeon or neurosurgeon, their first question is, "Will I need surgery?" Fortunately, only a small percentage of patients with a herniated disc need surgery.
There are many non-operative therapies that help reduce the pain and symptoms caused by disc herniation. The doctor may combine therapies for maximum benefit. Non-surgical treatment options include:
- Non-steroidal anti-inflammation drugs (NSAIDs)
- Short- or long-acting pain medication for the acute pain phase if needed
- Muscle relaxants to help relieve muscle spasms
- Physical therapy; passive treatments such as massage, ice/heat, TENS, and ultrasound
- Active physical therapy for flexibility, range of motion, endurance, and core building
- A home exercise plan
- Activity modification
- Information about ergonomics and injury prevention
- Spinal injections
Most herniated discs respond well to non-surgical treatments and symptoms usually resolve within 4 to 6 weeks. However, if non-operative therapies are ineffective, neurological problems develop, or pain is severe and unrelenting, a spine surgery may be recommended.