What is a herniated disc?
A spinal disc is a tough, rubbery-like tissue found between each of the spinal bones. The discs act as shock absorbers and allow the spine to be flexible.
When herniation occurs, the outer cover of the disc tears and the soft, jelly-like center of the disc leaks out into the space where the nerves are located. This can happen anywhere along the spine but typically occurs in the neck (cervical) and low back (lumbar) regions. The material that comes out of the disc causes very intense inflammation and agitates the nerves, causing pain. At times, the disc material can put pressure on a nerve and cause numbness or weakness.
What causes a herniated disc?
In the majority of patients, disc herniation is the result of a normal wear and tear on the discs as patients age (disc degeneration) due to water content lost over time. Factors that increase the risk of disc herniation include:
- Excess body weight that puts stress on the low back
- Genetic predisposition to developing a herniated disc
- Injury to the low back or neck
- Occupations that call for a lot of repetitive physical activity, including bending, twisting, pulling or lifting heavy objects
- Smoking, which constricts blood vessels and decreases oxygen and nutrient-rich blood flow to the discs
What are the symptoms?
Symptoms of a herniated disc can include:
- Arm and neck pain that can extend from the neck and upper back and radiate down the arm
- Low back pain that can radiate to the buttocks, calf or foot
- Muscle weakness that can cause stumbling or difficulty with lifting/holding items
- Numbness or tingling in the arms or legs
How is a herniated disc diagnosed?
Following a discussion about medical history, a physician will perform a physical exam to determine the source of the pain. A neurological exam will also be done to assess:
- For compression or tension on the nerves
- Muscle strength
- The ability to feel vibrations, pinpricks or light touches
- Walking ability
What diagnostic testing can be done?
Herniated discs usually can be diagnosed based on the physician’s examination. Further testing may be considered under certain circumstances. If a condition other than a herniated disc is suspected or there are findings on the exam of progressing nerve damage or spinal cord injury, further testing may be needed. Additional testing may also be considered if conservative treatment does not help after several weeks. Tests can include:
- A magnetic resonance imaging (MRI) scan to determine the locations of the herniated disc and the affected nerves
- An X-ray to rule out other causes for symptoms, such as a tumor, infection or issues with the alignment of the spine
- Electrodiagnostic testing to determine the severity of a nerve injury or to determine which specific nerve is injured
What are the treatments?
Conservative treatments work for most patients, resolving symptoms within a few days or weeks. These include:
- Over-the-counter (OTC) medications for mild to moderate pain
- Nerve-stabilizing medications to help treat pain that radiates to the arms or legs
- Cortisone (steroid) injections directly into the area where the affected nerves are to reduce inflammation and swelling
- Physical therapy exercises to minimize pain, improve strength and mobility and to teach patients how to protect the back and neck from further injury
- Narcotics (for a short amount of time) to relieve pain if OTC medications don’t
- Complementary therapies, such as acupuncture and chiropractic care, which can be offered as alternative options to other treatments
Should all other methods of treatment fail—which is rare for patients with disc herniation—surgery may be an option to remove part of the damaged disc or remove the entire disc and fuse the vertebrae together with hardware.
For more information on herniated discs or to schedule an appointment with a specialist, contact us today.