FAQ’s on Herniated Disc

 What is a herniated disc?

Herniated or Bulging Disc

Your spine is made up of a column of vertebrae that are separated by intervertebral discs. These discs are made up of soft, rubbery tissue. They act as shock absorbers, and allow the vertebrae to glide along each other, allowing you to flex, bend or twist your back. They are composed of a thick, tough outer layer of cartilage called the annulus fibrosus, and a soft, gelatinous inner substance referred to as the nucleus pulposus. The spinal column also houses the spinal cord and the other nerve roots, and serves as an attachment for muscles, ligaments and other soft tissues.

Disc herniation occurs when the central nucleus extrudes through the outer edge of the of the disc, compressing the spinal cord and nerve roots. The exact presentation of a herniated disc will depend on the location of the herniation as well as its extent. Pain can range from none to mild, to severe and debilitating.

The compression of the nerves can cause symptoms such as numbness, loss of sensation, muscle weakness, paralysis, and decreased reflexes. Irritation to the nerves can also occur, causing shooting pains along the nerve. It is also possible for the herniated disc to cause visceral pain.

While it is possible for herniated discs to regress spontaneously, most will require examination and treatment from a physician.

What causes herniated discs?

Disc herniation results from general wear and tear of the tough outer layer of the disc (annulus fibrosus). Thus, occupations that require constant sitting, squatting, lifting, and general pressure on the spinal column are more at risk for disc herniation. Excessive body weight, smoking, and age increase the risk of disc herniations.

How is a herniated disc diagnosed?

Your physician can arrive at a diagnosis of herniated disc from a complete medical history and physical examination. You may be asked to describe your symptoms, as well as the factors that trigger and aggravate the pain. Several physical tests can also be done in the clinic. Additional imaging studies such as X-rays, Computerized Tomography (CT) scans and Magnetic Resonance Imaging (MRI) scans may also be recommended.

How is disc herniation treated?

Herniated or Bulging Disc HoustonConservative, nonsurgical treatment has been shown to improve symptoms in more than 90% of patients. You may be prescribed medications for pain relief such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioid analgesics. Physical therapy to improve posture and to relax muscle tightness have also shown good outcomes.

Novel treatments such as epidural neuroplasty and steroid injections to the affected area have been shown to reduce pain and improve daily function in patients.

Surgery always carries risks, such as infection, intraoperative damage to the muscles and nerves, and blood loss. However, some studies have recommended early surgery for a quicker resolution of symptoms. An operation is usually recommended in the more severe cases, like when a disc fragment is compressing nerve roots, causing a significant loss of function and pain. This is treated by removing the herniated portion of the disc (discectomy or laminectomy), depending on the size and position of the herniation.

References:

Bajpai J, Saini S, Singh R. (2013). Clinical correlation of magnetic resonance imaging with symptom complex in prolapsed intervertebral disc disease: A cross-sectional double blind analysis. Journal of Craniovertebral Junction and Spine. doi: 10.4103/0974-8237.121619

Choi HS, Kwak KW, Kim SW, Ahn SH. (2013). Surgical versus Conservative Treatment for Lumbar Disc Herniation with Motor Weakness. Journal of Korean Neurosurgical Society. doi: 10.3340/jkns.2013.54.3.183

Kim ES, Oladunjoye AO, Li JA, Kim KD. (2013). Spontaneous regression of herniated lumbar discs. Journal of Clinical Neuroscience. doi: 10.1016/j.jocn.2013.10.008

Kim JH, Kang JI, Kim MJ, et al. (2013). Thoracic infectious spondylitis after surgical treatments of herniated lumbar intervertebral disc. Annals of Rehabilitation Medicine. doi: 10.5535/arm.2013.37.5.725

Tang YZ, Shannon ML, Lai GH, et al. (2013). Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain: discogenic visceral pain. Chinese Medical Journal. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24342313