The spine is comprised of individual bones called vertebrae, and in between each vertebra, is an intervertebral disc. These discs help to provide stability for the spine, and also act as shock absorbers. An intervertebral disc consists of two layers: an inner, jelly-like layer called the nucleus pulposus and an outer, fibrous layer called the annulus fibrosis. A herniated disc occurs when some of the inner layer of the intervertebral disc ruptures through a weakened point in the outer layer. A herniated disc can irritate nearby spinal nerves, which can result in back pain as well as numbness or weakness in the upper or lower extremities. The severity of disc herniation symptoms varies among patients, with some patients having no pain while others report debilitating pain. Disc herniations can occur throughout the spine; however, they are most common in the lumbar region (lower back), followed by the cervical region (neck). The most common symptoms of disc herniation include: Pain: If the herniated disc is in the lower back, the pain is likely to be the most intense in the buttocks, thigh, and calf on the affected side. It may also affect the foot. On the other hand, if the herniated disc is in the neck, the pain is likely to be the most intense in the shoulder and arm. The pain may have a shooting quality into the extremities when a patient coughs, sneezes, or moves in certain ways when a disc herniation is present. Tingling or numbness: These sensations may be felt in the area supplied by the nerves that are being irritated by the disc herniation. Weakness: Muscles that are supplied by the irritated nerves may weaken when a disc herniation occurs.
The most common cause of disc herniation occurs due to gradual, age-related, wear and tear, which is known as disc degeneration. The intervertebral disc lose some of their water content during the normal aging process, which make them less flexible and more prone to injury. Oftentimes patients are unable to identify the cause of their herniated disc. However, sometimes heavy lifting or improper lifting technique can be to blame. In rare instances, a traumatic event such as a motor vehicle accident or a slip and fall can result in a disc herniation. A number of individual risk factors have been identified that increase an individual’s risk of suffering a disc herniation, including: Obesity: Excess body weight places extra stress on the intervertebral disc in the lumbar spine, making them more prone to herniation. Physically demanding occupations: Jobs that entail repetitive lifting, twisting, pushing, or pulling increases the risk of suffering a herniated disc. Genetics: Certain individuals have a genetic predisposition to developing a disc herniation.
Most herniated discs can be diagnosed with a history and physical examination. The physician will ask questions about the patient’s medical history as well as specific questions pertaining to their current pain episode. The physical exam may include: Inspection and palpation of the area Range of motion testing Reflex, sensation, and muscle testing Orthopedic testing Imaging tests, including X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) may be ordered to rule out other pathology, or to determine the affected spinal level. Additionally, nerve conduction tests may be ordered if nerve damage is suspected, as it will help to determine the extent and location of the damage. Disc Herniation | PainDoctor.com Treatment for pain associated with disc herniation usually begins with pain medications, non-steroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. If a patient’s pain does not respond to these medications, narcotics may be prescribed to provide short-term pain relief. Furthermore, certain antidepressants, such as amitriptyline, may be recommended. Epidural steroid injections or nerve blocks may be suggested for relief of pain as well. A corticosteroid and anesthetic are injected into the epidural space for an epidural steroid injection; whereas the medication is injected directly into the affected nerve root during a nerve block procedure. A course of physical therapy or chiropractic care may be recommended. A physical therapy program may consist of a variety of modalities including ice and heat packs, ultrasound, traction, electrical stimulation, and manual therapy. In addition, the physical therapist will educate the patient on proper body mechanics and will also develop an exercise program to strengthen muscles in the affected area. A chiropractor may perform some of these modalities, in addition to providing spinal manipulation. Surgery may be necessary for patients who do not respond to conservative measures, especially if the patient continues to experience numbness or weakness in the extremities, difficulty with standing or walking, or if they have a loss of bowel or bladder control. A discectomy may be performed to remove the herniated disc material that is irritating the spinal nerves. Rarely, the entire intervertebral disc needs to be removed. In these cases, fusion of the vertebrae with metal hardware may be needed to provide stability to the spine.
Disc herniation is a relatively common occurrence and is a leading cause of low back pain. Disc herniation occurs when the inner layer of an intervertebral disc ruptures through the fibrous outer layer, resulting in irritation of nearby spinal nerves. This can result in chronic back pain. Numbness, tingling, and weakness of the extremities may also occur in some individuals. The most common cause of disc herniation is normal wear and tear that occurs with aging; however, acute injuries may also lead to this condition.
Usually treatment for disc herniation involves a variety of conservative treatment methods including pain medication and anti-inflammatory drugs, and muscle relaxants. Opioids and antidepressants may be recommended in some cases. Additionally, non-invasive treatment options for disc herniation pain relief include physical therapy, chiropractic care, and steroid injections. For patients experiencing debilitating pain, or for those experiencing persistent numbness, tingling, and weakness of the extremities, despite undergoing conservative care, surgery may be necessary.