Vertebral discs are soft tissue that act as a shock absorbing system between the vertebrae that make up the spine (also called intervertebral discs). The discs are composed of an outer layer of tough cartilage (annulus) that surrounds softer, jelly-like cartilage (nucleus). A herniated disc is a vertebral disc that has torn open, allowing the soft interior material to protrude.
Sometimes medical professionals will refer to a herniated disc as a slipped disc, ruptured disc, disc protrusion, prolapsed disc, or pinched nerve. These terms have technical variations in their meaning, so ask your doctor to explain your exact condition when using one of these terms.
Any disc in the spine can become herniated, but herniated discs more frequently occur in the lumbar (lower) and the cervical (neck) regions of the spine. Lumbar disc herniations are the most common cause of lumbago and leg pain (sciatica).
A herniated disc usually occurs when a person is in their thirties or forties, and the soft liquid interior of the discs (nucleus pulposus) is still a gelatin-like substance. As a person ages, the liquid changes and the risk of herniation is less likely. After age 50, the most likely cause of low back and leg pain is osteoarthritic degeneration (spondylosis) or spinal stenosis. Generally, men have a slightly higher risk of a herniated disc than females.
As the vertebral discs degenerate from age or injury, the softer central, jelly-like cartilage (nucleus) can protrude through the surrounding outer ring (annulus). This abnormal rupture of the central portion of the disc and resulting protrusion is referred to as a disc herniation or herniated disc.
The most common location for a herniated disc is in the vertebrae of the lower back (lumbar). This area of the spine must continually absorb the impact of the weight of the upper body. The lower back is also critically involved in our body’s movements throughout the day, as we twist the torso in rotating side to side and in flexing when bending or lifting.
If the protruding portion of a herniated disc is large enough, the disc tissue can press against adjacent spinal nerves causing pain. The tear in the disc’s outer ring may also allow a release of the jelly-like interior causing inflammation, which can trigger pain even if it does not place pressure on a nerve.
Most minor herniations heal within several weeks.
What Causes a Herniated Disc?
Disc herniation is most often the result of age-related wear and tear. Trauma can also cause disc herniations.
As the body ages, the spinal discs gradually lose some of their jelly-like interior contents, making them less flexible. Aging also makes vertebral discs more likely to tear or rupture with minor physical exertion.
Some of the factors that increase the risk of a disc herniation include:
Weight. Excess body weight places extra stress on the discs in the lower back.
Occupation. Anyone with a physically demanding job has a greater risk of developing back problems. Repetitive lifting, pulling, pushing, bending, and twisting can also increase the potential for a herniated disc.
Genetics. Some people inherit a predisposition to developing a herniated disc.
What are the Symptoms of a Herniated Disc?
Symptoms of a herniated disc vary depending on the location and other tissues impacted. The symptoms range from little or no pain (if the injury is to the disc alone), to severe, unrelenting chronic neck or back pain that radiates into other areas of the body. The most common signs and symptoms of a herniated disc are:
Arm or leg pain. If the herniated disc is in the lower back, the pain is typically in the buttocks, thigh, and calf. There can also be pain in the foot. If the herniated disc is in the neck, the pain will typically be in the shoulder and arm.
Numbness or tingling. Sometimes a herniated disc will cause numbness or tingling in the body part connected to the affected nerves.
Weakness. A disc herniation tends to cause muscles served by the affected nerves to weaken. This weakness can cause stumbling when walking, or impair the ability to lift and hold items.
Paralysis. Although not as common, a herniated disc can cause the loss, or impairment, of voluntary movement in a body part.
The nerve damage from a herniated disc can sometimes result in the loss of bowel and bladder control, and sexual dysfunction. However, it is possible to have a herniated disc without any pain or noticeable symptoms, depending on its location.
The two main causes of pain from a herniated disc are a pinched nerve and disc pain.
Pinched Nerve. When there is a disc herniation, the disc itself is not painful. Instead, the jelly-like material inside the disc is pinching or irritating a nearby nerve. This is radicular pain (nerve root pain) that leads to pain radiating to other parts of the body, such as from the lower back into the legs (sciatica), or from the neck into the arms. The pinched nerve can be the cause of Spinal Stenosis and spinal arthritis.
Disc Pain. When a patient suffers from a degenerated disc, the disc space itself is the source of the pain, which is called axial pain.
A physical exam and medical history are required to diagnose a herniated disc. However, to confirm or rule out other causes of the symptoms, such as spondylolisthesis, degeneration, tumors, or metastases (cancer), one or more of the following tests can be used to help in the diagnosis and to determine the best treatment options.
Neurologic Examination. This tests reflexes and muscle strength, while also assessing pain that spreads to other parts of the body. The exam may also test walking ability and the patient’s ability to feel light touches, pinpricks, or vibration on the skin.
Straight Leg Raise Test. Pain from a herniated disc can often be elicited when a straight leg is raised while lying or sitting. The test helps determine if there is an abnormal sensation in the foot or leg.
Blood Test. A variety of blood tests can help determine whether inflammation or an infection is the cause of the pain.
X-ray. Although traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, they are still used to confirm or exclude other possibilities such as tumors, infections, and fractures. X-rays can show “wear and tear” (degeneration) of the spine.
Computed Tomography scan (CT or CAT scan). This imaging test combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images. Although this scan can show the shape and size of the spinal canal, its contents, and the structures around it, including soft tissues, visual confirmation of a disc herniation can be difficult with a CT.
Magnetic Resonance Imaging (MRI). Radio waves and a magnetic field creates three-dimensional images of body structures. An MRI performed with a high magnetic field strength usually provides the most conclusive evidence for the diagnosis of a disc herniation and evidence as to which nerves are affected.
Myelogram. This imaging test uses a contrast dye and X-rays to look for problems in the spinal canal, including the spinal cord, nerve roots, and other tissues. The test can reveal the presence of structures that can put pressure on the spinal cord or nerves, such as herniated discs, tumors, or bone spurs. Myelograms provide excellent outlines of space-occupying lesions, especially when combined with CT scanning (CT myelography).
Electromyogram and Nerve Conduction Studies (EMG/NCS). These tests measure how well electrical impulse move along nerve and muscle tissue. The test indicates whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury, or whether there is another site of nerve compression. EMG/NCS studies are typically used to pinpoint the sources of nerve dysfunction caused by a spinal nerve root compression.
Transcranial Magnetic Stimulation (TMS). This test includes a magnetic method that stimulates small regions of the brain to measure disorders affecting the spinal cord.
Discography (Discogram). This test uses imaging guidance to direct an injection of contrast material into the center of a spinal disc to help identify the source of back pain. If a patient has not responded to non-surgical treatments, a discography may be used for surgical planning.
How is a Herniated Disc Treated?
The majority of spinal disc herniation cases don’t require surgery. Within the first six weeks, pain medications and therapies are the first lines of treatment to alleviate the pain and give the disc herniation time to heal. With time, the body can absorb the disc herniation. If the symptoms subside within the initial six-week period, a continuation of the non-surgical treatment is justified.
There are a variety of non-surgical treatments that may help relieve the pain from a herniated disc. However, no single treatment option works for everyone, so it’s best to consult a doctor.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs). Initial treatment usually begins with non-steroidal anti-inflammatory pain medication. However, long-term use of NSAIDs for people with persistent back pain can create cardiovascular and gastrointestinal problems. The use of NSAIDs is often in combination with other non-surgical treatments.
Acupuncture. The ancient Chinese practice of inserting needles in specific locations is thought to trigger the release of endorphins into the blood stream. Endorphins are the body’s natural pain relievers and help decreases the perception of pain.
Acupressure. Similar to acupuncture, acupressure relies on fingers, hands, and elbows to administer pressure. This ancient technique is thought to help restore a healthy flow of energy through the body by stimulating specific meridian points.
Epidural Corticosteroid Injections. The effects of epidural steroid injections vary, and the pain relief is temporary. They are intended to provide pain relief for patients during an episode of severe back pain while allowing them to make progress with rehabilitation.
Heat and Cold. Initially, the application of cold packs to the affected area can help relieve pain and inflammation. After a few days, switching to a gentle heat will provide both relief and comfort.
Massage. If done regularly, massage may offer relief of low back pain. The stroking, kneading, and manipulation of back tissues helps increase blood flow and deliver more oxygen and nutrients to the muscles. The increased extra blood also carries away waste byproducts that may accumulate over time.
Oxygen-Ozone Treatment. Oxygen-ozone gas is given via an injection into the herniated disc. A needle delivers the treatment directly to the disc and reduces the volume within the disc. This is due to the oxidation of proteins found within the gel-like center of the disc (nucleus). By reducing the disc volume, the pressure on nerves is also reduced. A 2015 study found the use of ozone therapy displayed several beneficial effects, including inhibiting inflammation and helping relieve pain.
Physical Therapy. A physical therapist can design exercises to help minimize the pain of a herniated disc. Physical therapy may include traction, electrical stimulation, and other methods to temporarily relieve pain. Sometimes, simple stretching can be very beneficial. Stretching generally involves slowly and carefully stretching the back.
Proper Body Mechanics. Proper lifting techniques, in addition to correct sitting and walking posture, play a role in reducing the stress on a herniated disc in the lower back.
Spinal Manipulation. Evidence suggests that spinal manipulation is effective for both lumbar disc herniation and acute sciatica.
Weight Control. Excess weight creates extra stress on the back. By losing weight, and maintaining a healthy weight, it is possible to reduce stress on the lower back.
Yoga. A combination of physical activity, breathing exercises, and meditation may improve function and relieve chronic back pain in some patients.
It is important that patients avoid too much bed rest, which can lead to stiff joints, weak muscles, and complicate the recovery. If possible, rest in a comfortable position for no more than 30 minutes, and then go for a short walk. Also, doing light work is good therapy, but the patient should avoid any activities that worsen the pain.
Surgery may be useful if non-surgical treatments have not provided adequate pain relief from a herniated disc. The following back surgeries are options:
Artificial Disc Replacement. Surgically removing the herniated disc and implanting an artificial disc (also called a disc replacement, disc prosthesis, or spine arthroplasty device). The device imitates the functions of a normal disc. This surgery may replace the entire disc or just the disc nucleus. In a disc nucleus replacement, the outer part of the disc (the annulus) is not removed.
Laparoscopic Spine Surgery. This operation removes a severely degenerated disc, or bonds two vertebral bodies together to stop unstable motion that causes pain.
Lumbar (Open) Microscopic Discectomy (Microdiscectomy). This is the most common surgical procedure for ruptured or herniated discs of the lumbar spine. The procedure removes a portion of the damaged disc to relieve pressure on the nerve tissue and alleviate the pain.
Spinal Fusion. This procedure joins, or fuses, two or more vertebrae. The process involves placing bone grafts around the vertebrae which grow together. Metal implants may be used to hold the vertebrae together until new bone grows between them.
Is it Possible to Prevent a Herniated Disc?
Though a herniated disc can result from normal wear and tear, it’s important to maintain a healthy spine while avoiding spinal injuries.
Exercise. Remaining active and exercising contribute to strengthening trunk muscles which help stabilize and support the spine.
Maintain good posture. The pressure on the spine and the discs can be reduced by maintaining a good posture. Keep the back straight and aligned, especially when sitting for long periods. Any lifting of heavy objects should be with the legs, and not by using the back.
Maintain a healthy weight. Excess weight places unnecessary pressure on the spine and discs, making them more susceptible to bulging and herniation.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating herniated disc pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.