Also called: Bulging disc, compressed disc, herniated intervertebral disc, herniated nucleus pulposus, prolapsed disc, ruptured disc, slipped disc
The bones (vertebrae) that form the spine in your back are cushioned by small discs. These discs are round and flat, with a tough, outer layer (annulus) that surrounds a jellylike material called the nucleus. Located between each of your vertebra in the spinal column, discs act as shock absorbers for the spinal bones. Thick ligaments attached to the vertebrae hold the disc material in place.
Over time the disc can wear out and lose its elasticity. When that happens the disc does not resist the pressure of bending, twisting and lifting and begins to bulge outward. Sometimes the bulging disc can rupture (or herniated) through the outer layer of the disc and push on the spinal sac of nerves, causing pain in the back and leg.
Herniated discs can occur in any part of the spine, but are more common in the lower back (lumbar spine), than in the neck (cervical spine). Herniated discs generally cause leg pain when they are located in the lower back and arm pain when they are in the neck.
Causes
A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as you age, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture. Certain individuals may be more vulnerable to disc problems, and as a result may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families, with several members affected.
Symptoms
Symptoms depend on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, you may experience a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness, or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.
Lumbar spine (lower back): Sciatica frequently results from a herniated disc in the lower back. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Along with leg pain, you may experience low back pain.
Cervical spine (neck): Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck.
Diagnosis
Diagnosis is made by a neurosurgeon based on your history, symptoms, a physical examination, and results of tests, including the following:
- Magnetic resonance imaging (MRI): A test that produces three-dimensional images of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, and discs, as well as degenerative changes and tumors.
- Myelogram: An x-ray and CT scan of the spinal canal following injection of a contrast material into the surrounding spinal sac, which can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.
- Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves, and muscle tissue. This will indicate whether there is nerve damage or whether there is another site of nerve compression.
Treatment
Fortunately, the majority of herniated discs do not require surgery. However, a very small percentage of people with herniated, degenerated discs may experience symptomatic or severe and incapacitating low back pain which significantly affects their daily life.
A herniated disc is occasionally treated with nonsteroidal anti-inflammatory medication, like ibuprofen, naproxen or sometimes by a tapering dose of oral steroid medication. An epidural steroid injection may be performed utilizing a spinal needle under x-ray guidance to the exact level of the disc herniation.
Your doctor may also recommend physical therapy. The therapist will perform an in-depth evaluation; which combined with the doctor’s diagnosis, will dictate a treatment specifically designed for patients with herniated discs. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation, and stretching exercises. Pain medication and muscle relaxants may also be beneficial in conjunction with the physical therapy.
Surgery
Your doctor may recommend surgery if conservative treatment options, such as physical therapy and medications do not reduce or end the pain altogether or if you have significant nerve damage and weakness. He or she will talk to you about the types of surgery available, and depending on your specific case, will help to determine what procedure might be an appropriate for you.
The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help every individual.
You may be considered a candidate for spinal surgery if:
- Back and leg pain limits normal activity or impairs your quality of life
- You develop progressive neurological deficits, such as leg weakness and/or numbness \
- You experience loss of normal bowel and bladder functions
- You have difficulty standing or walking
- Medication and physical therapy are ineffective
Surgical Terms:
- Artificial disc surgery – Surgical replacement of a diseased or herniated lumbar disc with a manufactured disc.
- Discectomy – Surgical removal or partial removal of a herniated intervertebral disc fragment.
- Laminectomy – Surgical removal of most of the bony arch, or lamina of a vertebra.
- Laminotomy – An opening made in a lamina, to relieve pressure on the nerve roots.
- Spinal Fusion – A procedure in which bone is grafted onto the spine, creating a solid union between two or more vertebrae; and in which instrumentation such as screws and rods may be used to provide additional spinal support.
Prevention Tips
Once you have recovered from surgery and have checked with your doctor, you may resume moderate exercise. The following tips may be helpful in preventing low back pain and herniated discs.
- Do crunches and other abdominal-muscle strengthening exercises to provide more spine stability. Swimming, stationary bicycling and brisk walking are good aerobic exercises that generally do not put extra stress on your back.
- Use correct lifting and moving techniques, such as squatting to lift a heavy object. Don't bend and lift. Get help if an object is too heavy or awkward.
- Maintain correct posture when you're sitting and standing.
- If you smoke, quit. Smoking is a risk factor for poor healing and atherosclerosis (hardening of the arteries) which can cause lower back pain and degenerative disc disorders.
- Maintain a healthy weight. Extra weight, especially around the midsection, can put additional strain on your lower back.
For more information about the NeuroTexas Institute Spine Center or to schedule a consultation, click here.
Information from the National Institutes of Health, November 2008
