HERNIATED DISC

Herniated Disc

A herniated disc, also known as a slipped or ruptured disc, occurs when the inner, softer portion of a spinal disc bulges out through a tear or crack in the outer, tougher portion of the disc. This will put pressure on the nerves in the spinal cord.  When that happens, a person will have pain, numbness, tingling, or weakness in the affected area of the body. Herniated discs most commonly occur in the lower back (lumbar region) and neck (cervical region). Treatment options include physical therapy, pain medication, and in some cases surgery.

A herniated disc will cause pain.  The disc or the rubbery cushions that sit between the vertebrae of the spine will have an issue. A herniated disc can occur anywhere in the spine, but it most commonly happens in the lower back. Depending on the herniated disc’s location, it can cause pain, numbness, or weakness in an arm or leg.

Herniated Discs and their Spine Locations

Herniated discs can occur in different regions of the spine, specifically the cervical (neck) region, the thoracic (mid-back) region, and the lumbar (lower back) region.

• Cervical disc herniation: This type of herniation occurs in the cervical region of the spine, which is made up of the seven vertebrae in the neck. A cervical herniated disc can cause symptoms such as neck pain, radiating pain or numbness in the arm and shoulder, and weakness in the arm or hand.
• Thoracic disc herniation: This type of herniation occurs in the thoracic region of the spine, which is made up of the twelve vertebrae in the mid-back. Thoracic herniated disc is less common than cervical or lumbar herniated disc, and the symptoms can vary depending on the location and size of the herniation.
• Lumbar disc herniation: This type of herniation occurs in the lumbar region of the spine, which is made up of the five vertebrae in the lower back. A Lumbar herniated disc can cause symptoms such as lower back pain, radiating pain or numbness in the leg and foot, and weakness in the leg or foot.

It’s important to note that the location of the herniated disc can affect the symptoms and the treatment options. In general, cervical and lumbar herniated discs are more common than thoracic herniated discs.  The lumbar herniated disc is the most common type of herniated disc.

The Different Types of Herniated Discs

A herniated disc occurs when the inner, softer portion of a spinal disc bulges out through a tear or crack in the outer, tougher portion of the disc. The following are different types of disc herniation:

• Protrusion: A protrusion is a herniation where the disc bulges outwards but does not completely rupture. This type of herniation is less severe than other types and may not put pressure on the nerves.
• Extrusion: An extrusion is a herniation where the disc material has ruptured and is bulging outwards. This type of herniation is more severe than a protrusion and may put pressure on the nerves.
• Sequestered: A sequestered herniation is an extrusion where the disc material has completely broken off and migrated away from the main disc. This type of herniation is the most severe and can put significant pressure on the nerves.
• Central: Central herniations occur when the herniation is located in the center of the disc. This type of herniation can compress the spinal cord causing severe symptoms.
• Posterolateral: Posterolateral herniations occur when the herniation is located on the back side of the disc and to the side. This type of herniation can compress the nerve root causing radicular symptoms.
• Foraminal: Foraminal herniations occur when the herniation is located in the foramen, a small opening where the nerve exits the spine. This type of herniation can compress the nerve root causing radicular symptoms.

It’s important to note that these types of herniations can be classified according to the degree of severity and the direction of the herniation and sometimes it’s not easy to classify them. The diagnosis and classification of a herniated disc should be made by a specialist.

Symptoms

Symptoms of a herniated disc can vary depending on the location of the disc and the severity of the injury. Some common symptoms include:

• Low back pain or neck pain, which may be severe and radiate to other areas of the body such as burning, tingling, and numbness that extends from the buttock into the leg and down to the foot.
• Numbness, tingling, or weakness in the affected area of the body, such as the legs, arms, or shoulders
• Muscle weakness, especially in the legs
• Loss of reflexes
• Difficulty walking or standing up straight
• Loss of bowel or bladder control (in severe cases)

It’s worth noting that many people have herniated discs but have no symptoms. It’s only when the herniation is large enough or pressing on a nerve that symptoms appear. And also some other conditions like spinal stenosis, arthritis, and osteoporosis may cause similar symptoms. So it’s important to get an accurate diagnosis from a doctor or specialist.

Leg Pain

A herniated lumbar disc compressing the sciatic nerve can produce sciatica, a type of nerve pain. There are two sciatic nerves, which appear on each side of the body. The sciatic nerve starts in the spine and extends down the leg. When a disc protrudes and presses on the sciatic nerve, pain radiates down the leg and below the knee, and perhaps even into the foot.

Causes

A herniated disc can be caused by a number of factors, including:

• Age-related wear and tear: As we age, the discs in our spine can lose water content, making them more prone to injury.
• Trauma or injury: A traumatic injury to the spine, such as a car accident or fall, can cause a herniated disc.
• Repetitive motions: Repetitive motions, such as lifting heavy objects or performing the same movements over and over, can put stress on the discs in the spine and lead to a herniated disc.
• Poor posture: Poor posture, such as slouching or hunching over, can put extra pressure on the discs in the spine and lead to a herniated disc.
• Genetics: Some people may be more prone to herniated discs due to genetic factors that affect the structure and function of the spine.
• Obesity: Obesity can put extra stress on the spine and increase the risk of a herniated disc.
• Coughing:  Chronic coughing and sneezing can cause a herniated Disc
• Nearby Nerve: Because spinal structures and nerves are near each other, irritation and pressure on the nerves do occur.

It’s also worth noting that a herniated disc can also happen without any known cause. It’s important to see a doctor or specialist if you’re experiencing symptoms of a herniated disc to determine the cause and the appropriate treatment.

Physical Examination for a Herniated Disc

A number of different examination methods can be used to diagnose a herniated disc. Some of the most common include:

• Physical examination: Your doctor will examine your spine and test your reflexes, muscle strength, and sensation.  This will help determine if a herniated disc is causing your symptoms.
• Medical history: Your doctor will ask about your medical history and any symptoms you’re experiencing.  This will help determine if a herniated disc is causing your pain.
• Imaging tests: Imaging tests such as X-rays, CT scans, and MRI scans can be used to visualize the spine and any herniated discs.
• Electromyography (EMG) and nerve conduction studies: These tests can help to determine if a herniated disc is causing nerve damage.  It measures the electrical activity of muscles and nerves.
• Myelography: A myelogram is an x-ray where a contrast dye is injected into the spinal canal before the X-ray is taken. This test is usually used when other imaging tests are not conclusive.

It’s worth noting that a herniated disc can cause similar symptoms to other conditions like spinal stenosis, arthritis, and osteoporosis.  So, it’s important to get an accurate diagnosis from a doctor or specialist. They will take into consideration all the factors and examination results to determine the diagnosis.

Treatment

Treatment for a herniated disc will depend on the severity of the injury and the symptoms that are present. Some common treatment options include:

• Physical therapy: Physical therapy can help to alleviate pain, improve flexibility, and strengthen the muscles that support the spine.
• Medications: Over-the-counter pain medications, such as ibuprofen and acetaminophen, can help to reduce pain and inflammation. Your doctor may also prescribe stronger pain medication or muscle relaxants if needed.
• Epidural corticosteroid injections: These injections can reduce inflammation and pain by delivering steroid medication directly to the affected area.
• Chiropractic care: Chiropractic care is a form of alternative medicine that can sometimes help to alleviate pain.  However, it will not provide a permanent solution.
• Surgery: Surgery is typically considered a last resort for herniated disc treatment. However, if symptoms are severe and do not improve with other treatments, surgery may be recommended.

Most people with a herniated disc will recover with conservative treatment like physical therapy, medications, and other treatments. But it’s important to consult with a doctor to determine the best course of treatment for your individual case.

Medical Advice for A Herniated Disc

If you have been diagnosed by one of our doctors at the Southwest Scoliosis and Spine Institute with a herniated disc, it’s important to follow your doctor’s recommendations for treatment and management. However, there are also some general tips that can help to alleviate pain and improve your overall well-being:

• Rest: It’s important to rest the affected area of the body as much as possible. Avoid activities that put unnecessary stress on the spine, such as heavy lifting or repetitive motions.
• Exercise: Gentle exercise can help to reduce pain and improve flexibility. Physical therapy can provide exercises that will alleviate pain and improve spinal function.
• Medications: Follow your doctor’s recommendations for taking pain medications or other medications as prescribed.
• Ice and heat: Applying ice or heat to the affected area can help to reduce pain and inflammation.
• Good posture: Good posture can help to reduce stress on the spine and alleviate pain.
• Maintain a healthy weight: Maintaining a healthy weight can help to reduce stress on the spine and reduce the risk of a herniated disc.
• Avoid smoking: Smoking can decrease the blood flow to the discs in the spine, making it harder for them to heal.

Conclusion

It’s also important to follow up with your doctor to monitor your progress and make any necessary adjustments to your treatment plan. We are experts in herniated disc diagnosis, treatment, and care. Southwest Scoliosis and Spine Institute’s board-certified, fellowship-trained orthopedic doctors, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have years of experience treating thousands of patients with complex spine conditions, including herniated lumbar discs.  Please contact us for any questions or to make your next appointment.