A herniated disc (or disc) happens when discs in the spine bulges from its proper place. discs are small circular cushions between the vertebrae (bones) in the spine. The discs are compressible and act as cushions for the bones of the spine. Herniated discs press on the nerves where they exit from the spinal column in close proximity to the disc and can cause severe pain. This is most common in the lower spine.
Herniated discs can occur when discs lose water content, become flatter, and provide less cushioning. If they become too weak, the outer part may tear. The inside part may then push through the tear and press on the nerves next to it.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Age: 30s and 40s
Trauma from a fall, accident, or sudden twisting
Strain on the back—either repeated or sudden (as from lifting a heavy weight)
Pain—the severity and location of the pain depend upon which disc is herniated
and how large the herniation is.
Pain may spread over the buttocks, down the back of one thigh, and into the calf
Pain may be in one or both (more rare) legs
Numbness, tingling, or weakness in the legs or feet
Cauda equina syndrome: involves bowel or bladder changes and/or numbness in the groin – this is an emergency, and needs immediate medical attention
In severe cases, inability to find comfort even lying down
Sudden aching or twisted neck that cannot be straightened without severe pain
Numbness, tingling, or weakness in one or both arms
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. You will also be asked specific questions about the pain and examine the spine. The doctor will test the movement, strength, and reflexes of the arms and legs.
Tests may include:
X-ray—a test that uses radiation to take a picture of structures inside the body, especially bones
CT scan—
a type of x-ray that uses a computer to make pictures of structures inside the body
MRI—a test that uses magnetic waves to make pictures of structures inside the body and allows both the bones and the disc to be seen
Diskography—a test that involves injecting a dye into the center of the disc and then taking an x-ray, which may show the dye leaking out
Electrodiagnostic testing—a test that measures the electrical activity of muscle by placing needle electrodes into the muscle (This can indicate whether the nerve signal to the muscle is firing normally.)
Myelography—a type of x-ray that uses dye injected in the space around the spinal cord to more clearly outline the space containing the spinal cord, the nerves, and show any disc herniation
Treatment
Treatments may include:
Physical Medicine
Bedrest
Back or neck massage and physical therapy to:
Relax the neck or back muscles
Decrease pain
Increase strength and mobility
After the acute phase, there are certain back and abdominal exercises that can help the recovery phase and prevent recurrences.
Hot or cold packs help reduce pain and muscle spasms.
Stretching the spine
A doctor or chiropractor can sometimes help reduce pain by stretching your spine.
Any spinal manipulation for a chronic disc problem must be done very carefully and only by an experienced, licensed practitioner.
Traction—weights and pulleys may be used to relieve pressure on the discs and keep the patient from moving around; this is more common for discs in the neck area.
Neck collar or brace—for a herniated disc in the neck, a neck collar or brace may be used to relieve muscle spasms.
Medications
NSAIDs—nonsteroidal anti-inflammatory medications, such as ibuprofen or naproxen, may be prescribed to reduce inflammation and pain.
Muscle relaxants—muscle relaxants may be prescribed to reduce muscle spasms.
Analgesics—various types of analgesic medications may be prescribed, depending on the level of pain.
Interventional Spine Care
Steroid injections—if medicine doesn't help, steroids may be injected into the area around the nerve and disc herniation backbone to reduce pain and inflammation.
Minimally invasive disc procedures—these include nucleoplasy and intradiscal electrothermy (IDET), chemonucleolysis—injection of an enzyme into the herniated disc to dissolve the protruding part.
Surgery
Surgery may be used for people who fail to respond to other treatments. Immediate surgery is necessary for cauda equina syndrome. Options include:
Laminectomy—removal of some of the bone overlying the spinal canal and of the protruding disc under that
Micro diskectomy—removal of fragments of herniated disc through a smaller incision without doing a laminectomy
Spinal fusion—fusing of vertebrae (back bones) together with bone grafts or metal rods (rarely done for first-time disc problems)
Prevention
The following strategies may help you reduce your chance of having a herniated disc:
Practice good posture—standing and sitting straight, keeping your back straight when lifting.
Maintain a healthy weight.
Exercise regularly. Ask your doctor about exercises to strengthen your back and stomach.
Don't wear high-heeled shoes.
If you sit for long periods of time, use a stool to bring your knees above your hips.
RESOURCES:
American Academy of Orthopedic Surgeons http://www.aaos.org
American Academy of Physical Medicine and Rehabilitation www.aapmr.org
American Chiropractic Association http://www.amerchiro.org
CANADIAN RESOURCES
Canadian Orthopaedic Association http://www.coa-aco.org/
Canadian Orthopaedic Foundation http://www.canorth.org/default.asp
References:
American Academy of Family Physicians website. Available at:
http://www.aafp.org/online/en/home.html.
American College of Physicians Complete Home Medical Guide. DK Publishing; 1999.
Awad JN. Moskovich R. Lumbar disc herniations: surgical versus nonsurgical treatment. Clinical Orthopaedics & Related Research. 443:183-97, 2006 Feb.
Ellenberg M, Honet JC. Frontera: Essentials of Physical Medicine and Rehabilitation. 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch 46.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
