What is a herniated disc?
Between the bones, or vertebrae, of the spine are the intervertebral discs, or just discs for short. The discs have an important function in stabilizing the spine. The discs absorb much of the load that the spine is subjected to when sitting or standing. When undue stress is placed on a disc, especially a degenerated disc, the material from the inside of the disc can exit the disc through a tear. The tear itself is usually caused by a combination of degeneration and stress. The resultant exited material is called a herniated disc.
What are the symptoms of disc herniation?
When the herniated disc pushes or irritates the passing nerves of the spine there is nerve pain. This causes pain radiating down the leg, arm or shoulder. When a nerve travelling to the leg is involved it’s called sciatica. Sometimes the herniated disc will cause pain in and of itself. This is felt as pain across the neck or back. If nerve compression is severe it can affect muscle function. If weakness in the arm or leg occurs one should seek medical attention urgently. If bowel or bladder incontinence occurs it is a medical emergency.
What causes disc herniation?
Commonly, there is an event resulting in severe pain that patients will recall. Most likely that event resulted in a painful tear of the disc. In the back, it usually results from a flexion and rotation motion while the back is under stress, such as carrying a heavy load. In the neck it can result from the violent flexion associated with a car accident, among other things. After the initial injury, there is weakening of the disc lining. This can cause a progressive herniation over time, or can cause repeated herniations. Sometimes the injury is not as well delineated. In these cases, a herniation is likely the result of chronic use and degeneration of the disc lining, causing a gradual tear.
How is disc herniation evaluated?
The first step in the evaluation of a painful herniated is a careful history and physical examination. It’s important to note that not every herniated disc is painful. In fact, most adults over the age of 40 have multiple, non-painful herniated discs. A careful evaluation is important in determining which disc, if any, or causing spinal pain. In patients who continue to have symptoms despite therapy and medications an MRI of the spine is often helpful.
How is disc herniation treated?
The first line in treatment of a painful disc herniation is medication and therapy. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which disc the pain is eminating from. Spinal injections can bring relief and confirm the source of pain. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
