HERNIATED DISC
HERNIATED DISC OVERVIEW
A herniated disc (also known as a slipped disc, ruptured disc, bulged disc or frank herniation) occurs when the inner, jelly-like material of a spinal disc pushes through or causes a bulge in the outer layer of a spinal disc, usually as the result of disc degeneration or a sudden, violent injury. However, they can also occur from, among other causes, sudden lower back movement, like lifting a heavy weight at the gym, picking up a big box while moving, or shoveling snow.
Herniated discs do not always cause pain, but they can if the inner disc material puts pressure on the sensitive nerves that surround the spine. If a disc herniation is impeding on a nerve the symptoms can include pain, numbness, weakness, tingling or burning that radiates from the back into the arms or legs.
Spinal disc herniations can appear anywhere in the spine but they most commonly occur in areas that bear the brunt of daily wear and tear, including the upper neck and the lower back.
Surgery is often not required to correct a herniated disc. Usually, a combination of rest, medication and physical therapy is enough to relieve the pain.
WHAT IS A HERNIATED DISC?
A herniation, according to Merriam-Webster is a medical term used to describe a protrusion “through an abnormal body opening.” Thus, a herniated disc is simply a spinal disc that has ruptured and has a protrusion coming through the opening.
WHAT ARE THE SYMPTOMS OF A HERNIATED DISC?
Regardless of their location, herniated discs exhibit some common, tell-tale symptoms, these can include:
Pain in your arms or legs. The exact location of your pain in your extremities will depend on the location of the herniated disc. Patients who have a ruptured disc in the lower back will typically feel pain in their buttocks, thighs or calves. However, symptoms can stretch all the way down to the foot depending on the location and severity of the herniation. If the herniated disc occurs in the upper neck (cervical spine), patients will often experience pain in their arms and shoulders. This pain is often made worse after standing or sitting for long periods of time or placing excessive pressure on the spine by bending over or leaning. Patients usually describe this pain as tingling, burning or shooting.
Tingling or numbness. A very common symptom of a pinched nerve is the experience of tingling or numbness. If you've ever had your foot "fall asleep" the feeling is somewhat similar. However, instead of the tingling going away with time, patients with a pinched nerve will often experience continual numbness or tingling in the body part affected by the pinched nerve; this is usually in the extremities like the arms or legs.
Muscle weakness. While somewhat rare, patients suffering from a herniated disc will occasionally experience weakness in their limbs, especially those that are impacted by the affected nerve.
When should you see a neurosurgeon?
Most of the symptoms from a herniated disc go away on their own with time and rest; some patients will need physical therapy or medication to help combat the pain. It’s relatively rare for a herniated disc to require surgery. However, if you are experiencing loss of bowel control, numbness, weakness, tingling or shooting pain that has lasted consistently for more than a week, it’s likely a sign that a nerve is impinged and you should see a neurosurgeon.
SHOULD I SEE A NEUROSURGEON OR AN ORTHOPEDIC SPINE SURGEON FOR MY HERNIATED DISC?
Despite marketing efforts to the contrary, there are key distinctions between neurosurgeons and orthopedic spine surgeons, learn the differences here.
WHAT CAUSES A HERNIATED DISC?
Herniated discs are caused when the inner material of a spinal disc bulges through the thicker, outer layer.
Spinal discs, also known as intervertebral cartilage, are essentially cushions that sit between each of the vertebrae of your spine and absorb all the shock that your back takes throughout the day. In a healthy spine, these discs are full of a gelatinous-like substance (known as the nucleus pulposus) which give them their ability to flex and compress. Meanwhile, the rigid outer shell of the disc (known as the annulus) ensures that everything remains contained and provides durability.
A great way to picture a healthy spinal disc is to think of jelly doughnut. The jelly represents the nucleus pulposus and the pastry represents the annulus.
However, as our bodies age and have experienced decades of constant wear and tear, the annulus (outside layer) of the disc naturally begins to weaken, this is commonly known as degenerative disc disease. For many people this organic degeneration isn't a problem and is completely asymptomatic, however in some cases this degeneration can cause the disc to collapse, crack or rupture, causing the nucleus pulposus to extrude outside of the disc, creating a herniation.
A disc can also herniate as a result of a sudden, violent movement — a car accident, for example. Also, any strenuous physical activities that involve pulling, heavy lifting, twisting, or other forms of hard labor, can also lead to herniated discs. In most cases of herniated discs, especially in older patients, this sort of sudden onset is not the case. It’s rare that a sufferer pinpoints the exact cause.
Depending on the location of the ruptured disc, the inner disc material can begin to put pressure on the sensitive nerve roots that exit from the spine. This can cause pain directly in the back or in the location connected to the impacted nerve root.
There are two types of nerve pain caused by herniated discs. The first, mechanical, is caused by a piece of the disc itself compressing the nerve. The second, chemical, is due to chemicals released by damage to the disc that irritates the nerve.
It's important to note that back pain can be a little tricky to self-diagnose. Most pain that occurs in the back is actually the result of strained, pulled or inflamed structures (like muscles or tendons) that support the spine. Pain in these areas can feel like it's emanating from the back when, in reality, it's coming from a different area entirely. One way you can determine the seriousness of your spine pain is to see how conservative treatments like rest, anti-inflammatory medication like ibuprofen, heat therapy and massages help your spine. If your condition improves after a couple of days, it was likely not a symptomatic spinal condition.
In contrast, pain from an acutely herniated disc can cause pain that may not improve with rest and medications. Leg raises are one test specialists frequently use to see if the pain in question is leg pain. In the case of herniated discs between the L4 and L5 vertebra, or between the L5 and S1 vertebra, pain at leg raises were accurate predictors of herniated discs 80% of the time. If you're experiencing daily pain from your spine that is not improving with conservative treatment, it's time to consider visiting a spinal specialist.
RISK FACTORS
Herniated discs can occur in just about anybody because, as has been mentioned previously, disc degeneration is a natural part of the aging process. However, there are several other factors that can make people more likely to experience a herniation. This includes:
Excess body weight
Smoking
Genetics/family history of herniated discs
WHAT DISCS CAN EXPERIENCE HERNIATION?
In theory, any disc is technically subject to herniation. However, barring accidents and unexpected, violent injuries, most occur in one of two places: the lumbar spine and the cervical spine.
HERNIATED CERVICAL DISC
A herniated cervical disc occurs in one of the seven cervical vertebrae (C1-C7) directly below the skull (your neck). While inflammation of the vertebrae can cause some pain and discomfort, most of the problems caused by a herniated disc result from pressure and friction on the nerves in the affected area.
HERNIATED LUMBAR DISC
A herniated lumbar disc occurs in the lumbar section of the spine (the lower back), the lowest section of the spine consisting of five vertebrae (L1-L5).
One common site of herniated discs are between the fourth and fifth lumbar vertebra (L4 and L5), or the fifth lumbar and first sacral vertebra (L5 and S1).
HOW ARE HERNIATED DISCS DIAGNOSED?
Diagnosis of a herniated disc requires a physical examination by a doctor. He or she examines your spine while bending or stretching, raising your legs, or walking. Your doctor may also look for loss of sensation in your legs or feet.
Imaging tests are used to rule out other causes of the pain. Your doctor may order imaging of the affected area, like an MRI, CT scan, or X-ray to determine if the disk is damaged or ruptured, as well as the extent of the damage. Once all of this data is collected, your doctor can recommend a treatment plan for your injury.
HOW ARE HERNIATED DISCS TREATED?
Treatment for herniated discs varies depending on the severity of the herniation and whether or not it’s impinging on any of the surrounding nerves.
CONCLUSION
Herniated discs are a common injury. If you suspect you might have a herniated disc, visit your doctor - don’t try to self-diagnose on your own.
Fortunately, many herniated discs can be treated through rest and hot or cold packs. Sometimes, your doctor may prescribe medication like a muscle relaxant, or he or she may prescribe physical therapy. Steroid injections are another possible treatment. These treatments usually improve the symptoms within 4 to 6 weeks.
Most disc herniations don’t need surgery, but if other treatments don’t improve the pain, your doctor may suggest surgery. Herniated disc operations should only be performed by a neurosurgeon.
Even if you need surgery, research has shown that it can provide substantial pain relief and high rates of success. Surgery patients go on to live full and active lives.
TREATMENT OPTIONS
Treatment options range from observation and pain regulation to minimally invasive surgery, although treatment differs depending on both the patient and the severity of the herniation. In severe cases where a surgical solution is required, we offer the following options:
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