The Herniated Disc
What Is a Herniated Disc?
Our spinal columns have to support our bodies, but they have to be flexible as well to facilitate movement. They have this flexibility because there are discs between the 24 bones of the spine (the vertebrae.) The discs have two sections that are essentially concentric rings. The outer ring (the annulus fibrosis) is flexible and tough while the inner ring (the nucleus pulposus) is soft like jelly.
The discs have an exterior casing, but when there’s damage to this and it ruptures, a disc can slip out of the proper alignment as the interior ring pushes against and through the exterior one. This bulging disc or slipped disc can then irritate the nerves in the spinal cord by putting pressure on them and producing chemical irritants that contribute to nerve inflammation.
Although they can occur anywhere along the spinal column, ruptured discs are most commonly in the lower back (the lumbar region) where they can produce lower back pain and sciatic leg pain (a sharp shooting pain that runs from the buttock down the back of one leg.) 60% to 80% of all individuals experience lower back pain at some point in their lives. The pain isn’t always the result of a bulging disc, but it can be.
What Causes a Herniated Disc?
As noted above, it’s a rupture of the exterior casing of a disc that can ultimately lead to a bulging disc. The damage most commonly comes from the wear and tear associated with aging although that’s not the only possible cause. Something like an injury can produce a herniated disc as well.
What Are the Risk Factors for a Herniated Disc?
There are several:
- If you’re overweight, you’re putting extra stress on your back.
- Men between 20 and 50 are most likely to develop a herniated disc.
- Improper lifting. You’ve probably heard you should lift with your legs and not your back. You truly should, and you should also avoid twisting your back while lifting to avoid a bulging disc.
- Frequent driving. The combination of sitting for a long while and the vibration from a car’s engine can exert stress on the spine.
- Repetitive actions that put a strain on the spine. A job that requires constant lifting, pulling, twisting or bending can also put a strain on the spine. Understandably, safe movement and lifting are particularly desirable in such a job.
What Are the Symptoms of a Herniated Disc?
A ruptured disc can cause a variety of symptoms related in part to its location along the spinal column. A herniated disc high in the back may affect the shoulders, and a bulging disc lower down can make its effect felt in the thighs. Wherever the bulging disc occurs, however, it generally produces numbness, tingling, and weakness in the affected area.
In the case of a herniated disc in the lumbar region, it’s also possible for the patient to experience a loss of bladder and bowel control. This is quite rare, but if it does happen, it may be a symptom of a condition called equine syndrome. In equine syndrome, spinal root nerves are being compressed, and the patient should have immediate medical care.
Can You Prevent a Herniated Disc?
Since that unfortunate rupture to the exterior casing of the problem disc most commonly occurs as a product of the aging process, you might infer the answer is no. In fact, however, there are things an individual can do to make a slipped disc less likely. Good posture serves to take stress off the spinal column, and so does exercise that strengthens the back muscles.
How Does a Doctor Assess a Herniated Disc?
The doctor will naturally begin by discussing the patient’s symptoms and medical history. After that comes a neurological examination. During the neurological exam, the physician looks for muscle weakness and loss of sensation.
More specifically, if a bulging disc in the lower back is suspected, he or she checks muscle strength in the lower legs. This involves asking you to walk on both your heels and your toes. The doctor may check muscle strength in other parts of the body as well.
Doctors check for loss of sensation by lightly touching affected areas.
Again if a bulging disc in the lower back is suspected, the doctor will test the patient’s reflexes at the knee and ankle. A deficiency in this area can indicate compression of a nerve root in the spine.
The straight leg raise (SLR) test provides a highly accurate test for a herniated disc in the lower spine if the patient is under the age of 35. Patients lie on their backs, and the doctor raises the affected leg while keeping the knee straight. Pain down the leg and below the knee likely indicates a ruptured disc.
Magnetic resonance imaging (an MRI) yields a clear picture of intervertebral discs (or the rest of the body’s soft tissues as required.) Doctors order them to confirm a diagnosis of a herniated disc or to obtain additional information. For individuals unable to tolerate an MRI, a computerized tomography (CT) scan or a CT myelogram are sometimes useful alternatives.
How Is a Herniated Disc Treated?
Common treatment interventions for a slipped disc include physical therapy, surgery, or steroid injections to relieve pain in the affected nerves.
It’s common to try nonsurgical interventions first. Sometimes one to two days of bed rest are all it takes to relieve symptoms. Even if that works, though, you should avoid sitting for long periods, take rest breaks during the day, make physical activity slow and controlled (especially bending and lifting), and avoid any movements that trigger pain.
NSAIDs like ibuprofen and naproxen can be helpful in reducing or eliminating pain.
When recommended, physical therapy often aims at strengthening the abdominal and lower back muscles.
Epidural steroid injections in the space around a nerve can sometimes relieve pain because of the anti-inflammatory effect of the cortisone-like drug being injected. Typically, however, the relief is only temporary.
Nonsurgical interventions help most people who have a slipped disc, but for those it doesn’t, doctors may recommend surgery. A common procedure is microdiskectomy, which requires a small incision and involves the removal of the herniated part of the disc along with any fragments that are also putting pressure on spinal nerves.
After surgery comes rehabilitation. A doctor or physical therapist often recommends a walking regimen coupled with specific exercises.
Generally speaking, microdiskectomy yields a favorable outcome although surgery does come with risks like infection, nerve injury, and hematoma resulting in nerve compression.
If you’re suffering from a herniated disc, we invite you to contact the Pain Relief Institute. Our medical experts have a variety of state-of-the-art techniques available to put an end to your distress.