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HERNIATED DISC

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HERNIATED DISC 

A herniated disc is a medical condition that affects the spine, in which the fibrous outer portion of the intervertebral disc ruptures or tears allowing the soft, jelly-like, central portion to squeeze or bulge out.

  • The spinal column is made up of 33 bones known as vertebra stacked onto each other.
  • Accordingly, the column includes 7 bones in the cervical spine, followed by 12 bones in the thoracic spine, and five in the lumbar spine, followed by five fused vertebrae in the sacrum and four fused vertebrae in the coccyx at the base.
  • Each vertebra is separated from the adjacent vertebra and cushioned by an intervertebral disc.
  • Each disc has two parts: a soft, gelatinous inner portion and an outer ring.
  • The disc helps to protect the bones by minimizing the impact of movements on the spinal column.
  • A herniated disc can occur in any part of the spinal column, they are more common in the lumbar spine, just above the hips.
  • A herniated disc can compress nearby nerves resulting in pain, numbness or weakness in arm or leg.

CAUSES

Disc degeneration can often be the result of a gradual, age-related wear and tear termed degenerative disc disease. As people age, the intervertebral discloses its water content as well as the ability to cushion the vertebrae. This reduction in fluid makes the discs less flexible and more prone to rupturing even with a little twist or bend.

In some cases, disc herniation may occur in young and healthy people as a result of injury or tear from lifting, large heavy objects. This injury may occur after twisting while lifting a heavy item or using the back muscle instead of the leg muscle while lifting heavy objects.

Certain factors that may increase the risk of a herniated disc may include:

  • Excess body weight
  • Genetics
  • An occupation that is physically demanding
  • Sedentary lifestyle

SYMPTOMS

A cervical herniated disc symptoms may include:

  • Pain in the neck, shoulders, or arms
  • Numbness or weakness in the neck, shoulders or arms

If the disc herniation is large and compresses the nerves in the spinal column, there may be

  • Numbness, weakness, and stiffness in the legs
  • Loss of bowel control
  • A difficulty with bladder control;

A thoracic herniated disc symptoms may include:

  • pain in the mid back
  • pain or numbness that travels from the back to the front of the chest or upper abdomen

If the disc herniation is large and compresses nerves in the spinal column, there may be

  • Numbness, weakness, and stiffness in the legs
  • loss of bowel control
  • A difficulty with bladder control

A lumbar herniated disc symptoms may include:

  • Persistent or continuous back pain that is worsened by movement, sneezing, coughing, or standing for long periods of time.
  • Unexplained muscle weakness in the leg
  • Difficulty walking
  • Incoordination
  • Changes in bowel or bladder function
  • Pain that starts near the back or bottom and makes it way all down the legs to the foot
  • Decreased reflexes at the knees and ankles

Typically, symptoms are experienced on one side of the body but in cases where the disc herniation is large and presses on the nerves within the spinal column, both sides of the body may be affected.

DIAGNOSIS AND TREATMENT

Diagnosis is made based on the history, symptoms and physical examination.

Physical examination may aim to check reflexes, walking ability, muscle strength, the range of motion, sensitivity to touch and the possibility of tender regions in the back.

If any other medical condition is suspected or the doctor needs to the location of the herniated disc and see which nerve is affected, the doctor may order MRI imaging, CT scan, or myelogram.

TREATMENT

Treatment options include medication, therapy, and surgery.

Medications may include:

  • Over-the-counter pain medications such as ibuprofen or naproxen
  • Doctors may prescribe narcotics such as codeine or an oxycodone-acetaminophen combination if OTC medication doesn’t improve pain
  • If muscle spasm is present, muscle relaxants may be prescribed
  • Cortisone injections that are injected directly into the area of the herniation to help reduce pain and inflammation

Therapy may be suggested if the pain does not resolve within a few weeks. Physical therapists may show patients positions and exercises designed to help relieve the pain

In very small cases, surgery may be required. Surgery may be suggested if other treatment options fail to improve your symptoms after a period of six weeks. Surgery may include either removing just the protruding portion of the disc or removing the entire disc. In cases where the entire disc is removed, metal hardware may be used to fuse the vertebrae together to provide spinal stability.

In very rare cases, the surgeon may suggest an artificial disk replacement