The bones of the spine (called vertebrae) are each cushioned by small discs. These small, flat, round discs have tough outer layer (the annulus) surrounding a jellylike material inside, called the nucleus.
A herniated (ruptured or slipped) disc is a portion of the disc nucleus which is pushed out of the annulus into the spinal canal by means of a rupture or a tear. Displacement of a disc presses on spinal nerves and can produce severe pain.
Herniated discs can occur in any part of the spine—although they are more common in the lower back (lumbar spine). They can also occur in the neck (cervical spine).
Causes of Herniated Disc
A strain or injury may cause a herniated disc, although disc degenerative disorder can also make this condition likelier, where even a minor back strain can injure a disc. Disc degeneration occurs naturally as one ages, so it is likelier to occur in individuals with time.
Signs & Symptoms
Position of the slipped disc and size of the rupture can determine the nature of the symptoms. If no nerve is impacted, an individual may just experience back pain, or even no pain. If it is impacting a nerve, however, the individual may experience pain, weakness in the area of the body affected by that part of the spine or numbness.
Sciatica results from a herniated disc in the lower back, causing a variety of sensations, including:
- Pain (usually sharp pain)
A herniated disc in the neck produces either dull or sharp pain in the neck between the shoulder blades, radiating pain traveling down the arm to the hands or fingers, or numbness in the arms or shoulders. Certain positions can make the pain worse.
Diagnosis & Testing
There are a variety of ways doctors can identify herniated discs, including: X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), myelogram (an X-ray of the spinal canal itself, using a contrast solution to show pressure areas), and electromyogram and nerve conduction studies (EMG/NCS, measuring electrical impulses along the nerves and muscle tissue, to determine the extent of nerve damage.
Most patients with herniated discs do not require surgery. Your physician may advise a reduction in activity for days or weeks, and may suggest bed rest, so that the inflammation can go down in the afflicted region.
Some nonsteroidal anti-inflammatory drugs may be used in mild-to-moderate cases.
Physical therapy may also be recommended, under the direction of a therapist in concert with your doctor’s diagnosis, and can include a combination of massage, ultrasound, ice and/or heat therapy, stretches and electrical muscle stimulation.
Surgery may be recommended if other treatment options are not successful. While the majority of patients who receive surgery to repair their herniated discs report significant relief after surgery, there is no guarantee that surgery will help everyone. Good candidates for surgery are individuals who meet the following criteria:
- Progressive neurological conditions like weakness or numbness in limbs
- Loss of bowel and/or bladder function
- Difficulty standing and/or walking
- Medication and physical therapy prove ineffective
- Pain in back and legs impairs quality of life
- Patient is in relatively good health
There are a variety of treatments available to individuals with herniated discs, including:
Discectomy: surgical removal or partial removal of a disc.
Laminectomy: surgical removal of most of the bony arch (lamina) of a vertebra.
Lumbar Laminotomy: an opening in a lamina to relieve pressure on the nerve root. This is often used to relieve sciatica or leg pain caused by a herniated disc.
Artificial disc surgery: replacement of a lumbar disc with a manufactured disc. This is a very specific form of surgery that only a few patients are eligible for, based on fitness, lack of success at other treatment options over a period of six months, as well as degeneration occurring in only one disc in a specific region of the spine (between L4 and L5 or L5 and S1).
Spinal fusion: Grafting bone onto the spine, creating a solid bond between two or more vertebrae, which may, in turn, be additionally supported by screws and rods.
In the case of cervical spine surgery, the surgeon will decide whether to operate from the front of the neck (anterior position) or the back of the neck (posterior position), based on the exact location of the herniated disc, as well as the preference and experience of the surgeon. After the disc is removed, it may be necessary to stabilize the spine, whether through use of a cervical plate and screws or through spinal fusion.