Herniated disc: causes, diagnosis and treatment
A herniated disc is a common condition that can be painful and debilitating. People also call it a slipped disc or disc prolapse. In some cases, this can lead to pain, numbness, or weakness in the limbs.
However, some people don’t feel any pain, especially if the disc is not pressing on any nerve.
Symptoms normally decrease or go away after a few weeks, but a person may need surgery if they persist or get worse.
This article will explore the treatment, diagnosis and prevention of a herniated disc.
Herniated discs can cause severe pain, but the right treatment can ease symptoms.
A person can mainly resolve symptoms by avoiding the movements that trigger the pain and following a doctor’s recommended pain medication and exercise regimen.
Treatment options include medication, therapy, and surgery.
Over-the-counter (OTC) medications: Medicines containing ibuprofen or naproxen can provide mild to moderate pain relief.
- Medicines for nerve pain: Medicines to treat nerve pain include gabapentin, pregabalin, duloxetine, and amitriptyline.
- Narcotics: If over-the-counter medications do not relieve the discomfort, a doctor may prescribe codeine, a combination of oxycodone and acetaminophen, or another type of narcotic. Side effects include nausea, sedation, confusion, and constipation.
- Cortisone injections: These can be injected directly into the area of the hernia to help reduce inflammation and pain.
- Epidural injections: A doctor injects steroids, anesthetics, and anti-inflammatory drugs into the epidural space, which is an area around the spinal cord. This can help minimize pain and swelling in and around the spinal nerve roots.
- Muscle relaxants: These help reduce muscle spasms. Dizziness and sedation are common side effects.
Physiotherapists can help find positions and exercises that minimize herniated disc pain.
Therapists may also recommend:
- heat or ice treatment
- ultrasound, which uses sound waves to stimulate the affected area and improve blood circulation
- traction, which can reduce pressure on the affected nerve
- short-term bracing of the neck or lower back, to improve support
- electrotherapy, as electrical pulses can reduce pain in some people
If symptoms do not improve with other treatments, if numbness persists, or if bladder control or mobility worsens, the attending physician may recommend surgery.
In most cases, the surgeon only removes the protruding part of the disc. This is an open discectomy.
The surgeon will usually perform an open discectomy using a laparoscopic technique, opening a small hole in the front or back of the spine.
This technique eliminates the need to remove small portions of the vertebrae or move the spinal nerves and spinal cord to access the disc.
Artificial disc replacement
Surgeons have performed disc replacement procedures since the 1980s in Europe but are not yet available in the USA.
There are two types. The first is a total drive replacement. The second is a disc core replacement which involves replacing only the soft center of the disc, known as the core.
Artificial discs are made of metal, biopolymer, or both. A biopolymer is a substance similar to plastic.
A slipped disc occurs when the soft inner section of an intervertebral disc protrudes through the outer layer.
The human spine, or spine, is made up of 26 bones called vertebrae. Between each vertebra are rubbery, cushion-shaped pads called “discs.” These discs help hold the vertebrae in place and act as shock absorbers.
The spinal discs have a soft, jelly-like center and a stronger exterior.
A herniated disc occurs when some of the inside is soft slide out through a crack in the wall of the disc. This most commonly occurs in the lower back, but can also occur in the neck vertebrae.
The leakage of this “jelly” is believed to release chemicals that irritate the nerves in the surrounding area and cause severe pain. The prolapsed disc can also put pressure on the nerves and cause compression pain.
The cause of a disc leak is usually progressive wear and overuse as a result of repeated movements over time.
Spinal discs lose some of their water content as a person ages. This reduction in fluid makes the discs less flexible and more prone to splitting.
It is not always possible to recall the exact point where a disc problem begins, but it often occurs when lifting objects without bending at the knee or after twisting while lifting a heavy object.
Herniated discs can occur at any age, but they are more common in men over 20 and 50 years old.
Factors that increase the likelihood include:
- Weight: Being overweight puts additional stress on the lower back.
- Genetic: A person can inherit a predisposition to a herniated disc.
- Occupation: People with physically demanding jobs or hobbies that involve pushing, pulling, or twisting are prone to a herniated disc. All repetitive activities that strain the spine can be the cause.
- Dangerous lifting technique: People should always apply strength from the legs, not the back, when lifting heavy objects. Incorrect technique can lead to a herniated disc.
- Drive often: A combination of sitting for long periods of time and the vibrations and movements of the car can damage the discs and the structure of the spine.
- Sedentary lifestyle: Lack of exercise can lead to a herniated disc.
- Smoking: This could reduce the oxygen supply to the discs and lead to crushing of the tissue.
In some cases, a person will not have any symptoms.
If symptoms do appear, they are often due to pressure on the nerves. Common symptoms can include:
- Numbness and tingling: It happens in the area of the body that the nerve supplies.
- Weakness: This tends to occur in the muscles related to the nerve, which can cause tripping when walking.
- Pain: It occurs in the spine and can spread to the arms and legs.
If the herniated disc is in the lower back, the pain often affects the buttocks, thighs, calves, and eventually the feet. This is often referred to as sciatica because the pain travels along the path of the sciatic nerve.
If the problem occurs in the neck, the shoulders and arms normally feel pain. Rapid movements or sneezing can cause shooting pain.
Below the waist, the spinal cord separates into a group of individual nerves, collectively called the ponytail or “ponytail.”
In rare cases, a herniated disc can compress all of this set of nerves.
This can lead to permanent weakness, paralysis, loss of bowel and bladder control, and sexual dysfunction.
If this happens, emergency surgery is the only option.
See a doctor if:
- There is a bladder or bowel dysfunction.
- The weakness progresses and prevents normal activities.
- There is increasing numbness around the inner thighs, back of the legs, and rectum.
A doctor can often diagnose a herniated disc with a physical exam.
They could check:
- possibility of tender areas at the rear
- Muscular force
- range of motion
- walking ability
- sensitivity to touch
An x-ray can help rule out other conditions with similar symptoms. Other types of imaging can provide more details about the location of the herniated disc, such as:
- MRI or CT scans: These can locate the location of the disc and the nerves affected.
- A discogram: This involves injecting a dye into the soft center of one or more discs to help locate cracks in the individual discs.
- A myelogram: this is the process of injecting dye into the cerebrospinal fluid, then taking an x-ray image. A discogram can show if a herniated disc is putting pressure on the spinal cord and nerves.
Tips for preventing a herniated disc include:
- avoiding obesity or losing weight, if necessary
- learn good lifting and handling techniques
- rest and seek help if symptoms appear
Although it can be extremely painful at times, a herniated disc has many promising treatment options.