We often speak about the spine as one bone, but it’s actually a series of smaller vertebrae, which are cushioned by discs. These discs are round, soft, and gel-like, and they have an outer layer that surrounds their nucleus. Between each vertebra of the spinal column, these discs act as shock absorbers for the spinal bones.
When a fragment of the disc nucleus is pushed out of its outer layer and into the spinal canal, this is known as a herniated disc (or a slipped, bulged, or ruptured disc). Discs often herniate when they are in the early stages of degeneration. Because the spinal canal has limited space, it is not adequately sized to house both the spinal nerve and the displaced herniated disc fragment at the same time. This lack of space means the disc presses on the spinal nerves, which can produce severe pain and other problems.
A herniated disc can occur in any area of the spine, though they are more common in the lumbar spine or lower back, though they are often in the neck or cervical spine as well. Depending on where the issue is, pain can occur in different areas of the body.
Causes of Herniated Discs
Most cases of disc herniation are a result of gradual wear related to age, known as disc degeneration. As we age, the discs in our spine become less flexible and more subject to tearing or rupturing in response to even a minor injury. While this is the most common cause, a disc can also become herniated in response to a major impact or injury. Car accident injuries and sports-related injuries are known to lead to herniation in many cases. Lifting improperly, twisting unnaturally, or a major fall can also be known causes. In this case, it is important to see a doctor immediately after an accident.
There are a number of factors that can increase your risk of suffering from disc herniation. Some of these factors include:
- Weight: Excess weight can cause extra stress on the discs in your lower back, speeding up degeneration.
- Occupation: If you work in a physically demanding environment, the risk of many back problems increases, including disc herniation. Repetitive activities like lifting, pushing, pulling, bending, and twisting can also increase your risk.
- Genetics: It is possible to inherit a predisposition to developing disc problems.
- Smoking: Some theories say that because smoking decreases the oxygen supply to the disc, it can lead it to more easily break down.
Symptoms of a Disc Herniation
Depending on the size and location of the affected disc, symptoms of the condition can vary greatly. In most cases, symptoms will be more present on one side of the body. In cases where the disc is not pressing on a nerve, you may notice a low backache, if you experience symptoms at all. But when the disc does impact a nerve, pain, numbness, or weakness may be present in the area of the body that relies on that nerve. A herniated disc is often preceded by period low back pain or a long history of episodic back pain. In addition to pain, numbness, tingling, and weakness are common symptoms.
When the disc is herniated in the lower back, it can often put pressure on the sciatic nerve, which is the largest nerve in your body and spans from your lower back down your hips and legs. Pressure on the sciatic nerve can cause pain, burning, tingling, or numbness that radiates from the buttock into the leg or foot. Most people describe the pain as feeling like an electric shock, and it may worsen with standing, walking, or sitting. Sciatica can include lower back pain, though the pain in the leg is often more severe.
If nerve compression is occurring in the neck, this is known as cervical radiculopathy and can cause dull or sharp pain in the neck or between the shoulder blades. This pain often radiates down the arm and into the hands or fingers, causing numbness and tingling. Certain movements or positions can make the pain worse.
When to Seek Medical Care
Most herniated discs are able to be treated without invasive options like surgery. However, when ignored or left untreated, problems can worsen and cause more problems down the line. Treatment time can vary from a few days to a few weeks once care is started.
If you suspect you have a herniated disc, start by limiting your activity for 2 or 3 days. Bedrest is not recommended, but you should rest and avoid any strenuous activities. Anti-inflammatory medication and alternating ice and heat therapy can help relieve pain during this time. If symptoms persist, you should consider medical care.
In cases where there are symptoms of serious leg or arm weakness, a loss of feeling in the genital or rectum region, loss of control of urine or bowel movements, infection or fever, or a fall caused by the pain, seeking urgent care is important.
When you seek medical evaluation, there are a number of tests and imaging procedures that a doctor may perform in order to confirm a disc herniation. You will start by discussing your symptoms, medical history, and any recent falls or injuries and then may undergo some of the following scans.
- X-Ray: A herniated disc will not appear on an x-ray, but it may be used to rule out other potential causes of pain, such as a fracture or a tumor.
- CT Scan: This imaging can show the size of the spinal canal, its contents, and structures surrounding it and may show a disc herniation.
- MRI: By producing a 3D image of the body structure, an MRI can show the spinal cord, nerve roots, and surrounding areas. This can help to highlight enlargement or degeneration that may have contributed to the herniation.
- Myelogram: An x-ray of the spinal canal, this is performed after an injection of contrast material into the cerebrospinal fluid in order to show pressure on the spinal cord or nerves that results from herniation of the discs.
These techniques can help a doctor determine the location and severity of your disc herniation in order to develop the proper treatment protocol.
Treatment of Disc Herniation
The initial treatment for a herniated disc is usually non-invasive. You may be advised to maintain low activity levels for a period of time in order to allow the inflammation to decrease. This can be helped by nonsteroidal anti-inflammatory medication, which may be performed using a spinal needle under x-ray guidance. This may be paired with physical therapy, making use of pelvic traction, gentle massage, ice and heat therapy, ultrasound, muscle stimulation, and stretching exercises in conjunction with main management techniques.
If more conservative options are not working to reduce or end pain, a doctor may recommend discussing surgical options. The benefits of surgery should be weighed against the risks, and age, overall health, and other factors may be taken into consideration when deciding what kind of surgery is more appropriate. Options include lumbar spine surgery, artificial disc surgery, or cervical spine surgery.
When no treatment is pursued, a herniated disc can worsen, compressing the entire spinal canal or causing damage to the impacted nerves. A progressive loss of sensation, bladder or bowel dysfunction, and worsening symptoms may be signs that the condition is deteriorating.
Preventing Disc Herniation
In order to prevent suffering from a disc problem, there are a number of things you can do. Maintaining a healthy weight and an active lifestyle avoids extra pressure and stabilizes the spine. Good posture and avoiding or quitting smoking will also help you avoid this painful condition.