What is a Herniated Disc?
A herniated disc, also known as a ruptured or slipped disc, is a damaged “cushion” between two bones in the spine (vertebrae). Normally, the gelatinous discs between the vertebrae hold the bones in place and act as shock absorbers, permitting the spine to bend smoothly. When a disc protrudes beyond its normal parameters and its tough outer layer of cartilage cracks, the disc is considered “herniated.”
Anytime a disc bulges through torn cartilage, it can press on a nerve in the spinal canal. This results in back pain; if pain extends to the buttocks and travels down the affected leg, it is called “sciatica” pain. Herniated discs occur most frequently in the lumbar (lower) region of the back, and are one of the most common causes of back pain. Cervical (neck) discs also herniate, resulting in pain in the neck and shoulders.
Herniated Disc Causes
During the normal process of aging, the discs in the back lose flexibility and wear down. Additional stress, whether from obesity, smoking, heavy lifting or sudden traumatic injury, can then cause herniation.
Herniated Disc Symptoms
In addition to pain emanating from the herniated area, patients can experience:
- Muscle spasms
- Muscle weakness
The pain that results from a herniated disc is usually worsens with movement, and improves with rest. Sudden motions, such as bending or coughing, can elicit sharp, shooting pain.
How is a Herniated Disc Diagnosed?
In order to make a diagnosis, a patient’s medical history is taken, and a determination made as to whether pain has been increasing gradually or was precipitated by a traumatic injury. A comprehensive physical exam, which includes a check of reflexes, sensation/numbness, posture, and muscle strength, helps in assessing the situation. Usually, the patient is examined sitting, standing and walking.
In most cases, imaging tests are administered to provide a more precise visualization of the spine. They are used to determine whether there is a disc injury and, if there is one, to delineate its size and location. Tests include X-rays, MRI or CT scans, electromyograms (which measure nerve impulses), and myelograms (in which contrast dye highlights the affected region).
How Do You Repair a Herniated Disc?
Conservative treatment for herniated discs usually begins with bed rest and taking anti-inflammatory and pain medications as needed. We may recommend applying hot or cold compresses, sometimes alternately. We may also prescribe muscle relaxants to diminish muscle spasms in the back. Sometimes, a course of physical therapy to stretch and strengthen back and abdominal muscles provides relief. Epidural injections of a corticosteroid is also an option to help reduce nerve irritation and facilitate healing. For some patients, chiropractic care or some type of alternative medicine provides relief.
Herniated Disc Surgery
When the condition does not respond to these measures, and the patient is still experiencing pain, surgery may be necessary. This is true in approximately 10 percent of herniated disc cases. The type of procedure performed depends on where the herniated disc is located, and the severity of the damage. There are several surgical options. Our office performs all of these in the hospital under general anesthesia:
- Laminotomy: the protruding portion of the disc is excised.
- Discectomy: the entire disc is removed.
- Arthroplasty: the herniated disc is replaced with an artificial disc.
- Spinal fusion: In more severe cases of herniation, spinal fusion may be necessary. During this procedure, vertebrae are fused using a bone graft or metal rod.
What is a spinal disc?
We have a total of 23 vertebral discs in our spinal column. They are composed of two parts. There is a tough outer shell and a soft inner core. You can think of them as similar to a jelly donut. The outer portion is called annulus fibrosus. It is tough and durable, made from concentric sheets of collagen fibers. The inner core is the nucleus pulposus. It is made up of a loose network of fibers suspended in a protein gel. The outer portion and inner core of a disc fit together like two concentric cylinders. At birth, the discs are very soft and malleable, composed of 80 percent water. This percentage of water drops continuously as we age, making the discs less and less gel-like as we get older.
Thank goodness my general practitioner sent me to DFW Center for Spinal Disorders! I could not sit or stand so the staff was very kind to get me in as fast as possible. – Georgia M
What Does the Discs do?
Our spinal discs have three primary functions:
- They act as shock absorbers between each bony vertebra.
- They act as tough ligaments, holding the individual vertebrae together to make the spine function as a single element.
- They are malleable and allow mobility in the spine.
What Causes A Disc to Herniate?
A disc “herniates” when the softer center pushes out through a tear in the outer annulus fibrosus. An exact cause, such as a car wreck or a fall, usually isn’t obvious. Instead, our discs usually herniate simply due to aging. Interestingly, after the age of 50 most people don’t have herniated discs any longer, as their discs have become so solid that they don’t herniate.
These are typical causes of a herniated disc:
- Wear and tear — The cause of most herniations is simply gradual wear-and-tear that occurs with our discs, due to their continual use. This is called disc degeneration. As we age and our discs lose more and more of their water content, they become less flexible. This makes them more prone to tearing or rupturing, sometimes from the simplest twisting motion.
- Injury — It’s easy to assume a disc herniates due to trauma, such as a fall or blow to the back, but this is rare. Disc injury that leads to herniation is more likely to the most seemingly mundane movements. It can happen if a person lifts items using the back muscles rather than the legs. It can happen when combining lifting and twisting at the same time.
- Combination — The reality is that most herniated discs are a combination of discs becoming less flexible with age and a movement that stressed the disc making it push through the outer shell.
Certain factors can increase your chances of developing a herniated disc:
- Weight — Excess weight produces more stress on the discs in your lower back.
- Occupation — Jobs that involve a lot of lifting, pulling, pushing, and bending and twisting have increased chances of herniating discs.
- Genetics — Some people inherit a tendency for the discs to herniate.
What if I Don’t Treat My Herniated Disc?
Just because a disc herniates doesn’t mean it absolutely needs treatment. Some people have a herniated disc and don’t have any symptoms. But it is more likely that when the inner portion of the disc pushes out through the exterior it will push on nearby nerves that are exiting the spinal column. This irritates the nerves causing pain, numbness, or weakness in an arm or leg (wherever the nerve is servicing).
If this is the case, leaving the disc untreated can lead to chronic pain. And if the nerve is being impinged enough, it can eventually lead to muscle weakness in the muscles served by the affected nerve. At DFW Center for Spinal Disorders, we treat herniated discs with a variety of different treatments. Surgery is necessary in only about 10 percent of cases.