Progressive Steps toward Lumbar Disc Herniation

	Jean-Jacques Abitbol, MD, FRCSC Orthopaedic Surgeon California Spine Group, MC San Diego, CA, USA
	Edgar G. Dawson, M.D.
	Regis W. Haid, Jr., MD Neurosurgeon Atlanta Brain and Spine Care Atlanta, GA, USA

Many factors increase the risk for disc herniation: (1) Lifestyle choices such as tobacco use, lack of regular exercise, and inadequate nutrition substantially contribute to poor disc health. (2) As the body ages, natural biochemical changes cause discs to gradually dry out affecting disc strength and resiliency. (3) Poor posture combined with the habitual use of incorrect body mechanics stresses the lumbar spine and affects its normal ability to carry the bulk of the body's weight.

Combine these factors with the affects from daily wear and tear, injury, incorrect lifting, or twisting and it is easy to understand why a disc may herniate. For example, lifting something incorrectly can cause disc pressure to rise to several hundred pounds per square inch!

A herniation may develop suddenly or gradually over weeks or months. The four stages to a herniated disc include:

1) Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation. 2) Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion. 3) Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc. 4) Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Locating the Cause of Pain
Interestingly, not every herniated disc causes symptoms. Some people discover they have a bulging or herniated disc after an x-ray for an unrelated reason.

Most of the time the symptoms prompt the patient to seek medical care. The visit with the doctor usually includes a physical and neurological exam; review of medical history, symptom evaluation and the history of treatments and medication the patient has tried.

An x-ray may be needed to rule out other causes of back pain such as osteoarthritis or spondylolisthesis. A CT or MRI scan verifies the extent and location of disc damage. Sometimes a myelogram is necessary.

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