Herniated Disc

The spinal column consists of a stack of vertebrae separated by discs, which cushion the forces on the spine and prevent the vertebrae from grinding against each other. A herniated disc occurs when a disc becomes misshapen and starts to bulge and then breaks open (ruptures). The substance inside the disc can leak out which may irritate and inflame the nerves.

Causes

A disc may herniate because of stress placed on the spine, overexertion, accident, or injury. Herniated discs may also be the result of degeneration (wear and tear) of the disc as the result of advancing age or repetitive stress injuries. Some of the most common causes of a herniated disc include:

  • A blow or excessive force to the spine (such as might occur in a severe fall or car accident)
  • Overexertion caused by lifting something improperly or twisting the back
  • Repeated stress place on the back

 

Terminology

The discs are made up of a ring of tough fibers (called the annulus fibrosus) protecting an inner capsule filled with a gel-like substance called nucleus pulposus. The annulus fibrosus holds the disc in place while the nucleus pulposus acts like a shock absorber.

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A herniated disc is one in which the disc bulges and then ruptures or breaks open.

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Herniated discs can occur anywhere in the spine but are most common in the lower back or lumbar region.

Symptoms

Symptoms of a herniated disc range from mild to severe and may include:

  • Back pain made worse by movement
  • Muscle spasms
  • Weakness in the leg or loss of leg function (herniated disc in the lumbar region)
  • Weakness in the arm or loss of arm function
  • Headache (herniated disc in the cervical or neck region)
  • Leg pain or burning, tingling pain that extends from lower back over the buttocks and down the legs (on one or both sides)

Treatment

There are ways to successfully treat a herniated disc and many of them do not require surgery.

In many cases, conservative treatments may be all that are necessary. In some patients, the pain associated with a herniated disc goes away on its own in four to six months. For that reason, pain management programmes and nonsurgical approaches may be recommended. Such treatment may involve any or a combination of the following:

  • Rest
  • Medications to reduce pain, reduce inflammation, and relax muscles
  • Epidural corticosteroid injections
  • Physical therapy
  • Special exercises
  • Braces to support the spine
  • Traction

There are cases where spinal surgery may be recommended. The most common procedures for herniated disc are:

  • Laminotomy (a portion of vertebral bone is removed to relieve pressure on the nerves)
  • Discectomy (the damaged disc is removed)

These surgical procedures may require fusion where two vertebrae are joined together and then packed with bone graft to “fuse” together over time.

Some hospitals may offer certain herniated disc patients the option of having these surgical procedures performed as minimally invasive surgery with small incision(s). Not all people with a herniated disc are candidates for surgery and not all surgical patients are candidates for minimally invasive surgery. Discuss the risks and benefits of potential surgical options with the team at the hospital.

Prognosis

Herniated discs can cause considerable pain, distress, and mobility restrictions, but often resolve over time. For that reason, many patients can be effectively treated with pain management and conservative approaches. Hospitals can offer expert care and advice as to when surgical therapy might be appropriate for an individual patient. In most cases, the pain and symptoms of herniated disc can be safely and effectively treated.

Risk Factors

Herniated discs have been associated with obesity, sedentary lifestyle (no exercise). Other risk factors include:

  • Spinal injury (repetitive stress or trauma)
  • Advanced age

 

Conclusion

A herniated disc occurs when the disc or “shock absorber” located between the vertebrae becomes misshapen, bulges, and breaks open. This may cause mild to severe pain and limited mobility. In many cases, a herniated disc repairs itself and pain diminishes over the course of four to six months, but in other cases, surgical treatment is advised.

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