Herniated Disk

What Is A Herniated Disk?

A herniated disc is also known as a prolapsed, slipped disc, ruptured disc or extruded disc. It occurs when some or all of the soft inner material of the disc (nucleus pulposus) pushes through the fibrous outer part of the disc (annulus fibrosus). This material can compress ligaments and nerves near the disc causing pain, as well as release chemical irritants that cause inflammation.

What Are The Symptoms?

Most herniated discs occur in the lower back, although they can also occur in the neck. Symptoms depend on where the herniated disc occurs and if any nearby nerves or structures are compressed; However, many people have no symptoms and the herniation is found accidentally on imaging. Herniated discs in the neck typically cause symptoms in the shoulder, arm and hand while herniations in the low back may cause symptoms in the buttocks, hip, leg and foot. Signs and symptoms may include:

  • Arm or leg pain: This pain is often described as sharp or burning. Coughing, sneezing or certain positions may cause this pain to shoot into your arm or leg.

  • Numbness or tingling: Radiating numbness or tingling in a body part.

  • Weakness: Muscles innervated by the affected nerves tend to weaken which can cause you to stumble, or affect your ability to lift and/or hold objects.

What Are The Causes?

Disc herniation is most often the result of disc degeneration since the discs become less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Improper lifting techniques that place increased stress on your back muscles instead of your leg and thigh muscles, as well as twisting and turning while lifting can cause disc herniation. Rarely, a traumatic event such as a fall or a blow to the back is the cause.

Risk Factors

Factors that can increase your risk of a herniated disc include:

  • Overweight/Obesity.

  • Occupation: Physically demanding jobs place people at a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting can increase your risk of disc herniation.

  • Genetics.

  • Smoking: This may lead to decreased oxygen supply to the disc, causing it to break down more quickly.

Diagnosis

A thorough history and physical examination by your doctor will help determine if a herniated disc may be causing your pain and/or symptoms. In most cases, this is all that’s needed for diagnosing a disc herniation. However, sometimes other tests are needed and may include:

  • X-rays: X-rays won’t detect a herniated disc but can rule out other causes of back pain.

  • MRI or CT scan: These tests can help visualize bone and soft tissue structures, as well as confirm the location of the herniated disc and to see which nerves are affected.

  • Myelogram: This test can show pressure on your spinal cord or nerves due to multiple herniated discs or other conditions.

  • Nerve conduction study (NCS): This test measures electrical nerve impulses and functioning in your muscles and nerves.

  • Electromyography (EMG): This test evaluates the electrical activity of your muscles when they contract and when they’re at rest.

What Are The Treatments?

In most cases, modifying activity to avoid painful movements and taking pain medication can relieve symptoms within a few days or weeks. Some of these can include:

Lifestyle and home remedies
  • Applying heat or cold: Initially, cold packs can be used to relieve pain and inflammation. After a few days, you might switch to gentle heat to give relief and comfort.

  • Avoiding too much bed rest: Staying in bed can lead to stiff joints and weak muscles — which can complicate your recovery. Instead, rest in a position of comfort for 30 minutes, and then go for a short walk or do some work. Try to avoid activities that worsen your pain.

  • Resuming activity slowly: Let your pain guide you in resuming your activities. Make sure your movements are slow and controlled, especially bending forward and lifting.

Medications
  • Over-the-counter pain medications: Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, etc) or naproxen (Aleve).

  • Muscle relaxers: You might be prescribed these if you have muscle spasms. Sedation and dizziness are common side effects.

  • Oral corticosteroids: Sometimes oral corticosteroids can help reduce the inflammation and pain associated with disc herniation; however, a corticosteroid injection is preferred as it reduces steroid side effects and complications.

  • Opioids: Because of the side effects of opioids and their potential for addiction, many doctors hesitate to prescribe them for disc herniation. If other medications don’t relieve your pain, your doctor might consider short-term use of opioids. Sedation, nausea, confusion and constipation are common side effects from these drugs.

Therapy
  • Physical therapy: The goal of physical therapy is to strengthen your core muscles, improve flexibility and learn positions designed to minimize the pain.

  • Chiropractic.

  • Acupuncture.

  • Massage.

Interventional
  • Cortisone injections: These injections are performed under fluoroscopic (x-ray) guidance to deliver corticosteroid medication near the spinal nerves to help reduce inflammation and allow you to get back to activity quicker.

  • Regenerative medicine injections: Platelet rich plasma (PRP), stem cell and/or exosome injections in the disc or near the nerves can stimulate your body to more rapidly heal and correct the problem.

  • Spinal cord stimulation: For treatment resistant herniated discs that cause severe pain, spinal cord stimulation can provide long term relief and improvement of symptoms and function.

Surgery

If conservative non-surgical treatments have failed to improve your symptoms, sometimes surgery is recommended. Your pain doctor will refer you to a trusted surgeon for evaluation. In most cases just the protruding portion of the disc is removed (discectomy). Rarely the entire disc needs to be removed which may also require a vertebral fusion or implantation of an artificial disc.

Lastly, there are interventional treatments such as injections or surgery. Injections, including cortisone injections, can help when your chronic pain becomes too severe to be managed by more conservative treatments. These injections have the potential to offer effective, long-term pain relief, but they can also cause serious side effects if used too frequently. Your doctor will help you decide if the risks are worth the benefits in your case. There are also multiple kinds of herniated disc surgery, including partial or total removal of the affected disc or the insertion of an artificial disc to replace the damaged one.