Herniated disc: causes, symptoms, diagnosis and treatment

A herniated disc refers to a problem with one of the cartilaginous cushions (discs) found between the bones (vertebrae) that stack together to form the spine.

A vertebral disc has a soft, gelatinous center (core) encapsulated in a harder, more rubbery exterior (ring). Sometimes called a slipped or ruptured disc, a herniated disc occurs when part of the core is pushed out through a tear in the edge.

A herniated disc, which can occur anywhere in the spine, most commonly occurs in the lower back. Depending on the location of the herniated disc, it can cause pain, numbness, or weakness in an arm or leg.

Many people do not have symptoms of a herniated disc. For people with symptoms, they tend to get better over time. Surgery is usually not needed to alleviate the problem.

Symptoms

Most herniated discs occur in the lower back, although they can also occur in the neck. Signs and symptoms depend on where the disc is located and whether the disc is pressing on a nerve. Usually, herniated discs affect one side of the body.

Pain in the arms or legs. If your herniated disc is in the lower back, in addition to pain in this area, you will usually experience pain in your buttocks, thigh, and calf. You might also have pain in one part of your foot.

If your herniated disc is in the neck, you will usually feel more shoulder and arm pain. This pain may appear in the arm or leg when you cough, sneeze or adopt certain positions. The pain is often described as sharp or burning. Numbness or tingling. People who have a herniated disc often have numbness or tingling in the part of the body where the affected nerves connect. Weakness. The muscles to which the affected nerves connect tend to weaken. It can cause you to trip or affect your ability to lift or hold objects.

You can have a herniated disc without symptoms. You may not know you have it unless it shows up on a spine picture.

When should you see a doctor?

Factors that can increase the risk of a herniated disc include: The weight. Excess weight causes additional stress on the discs in the lower back. Work. People with physically demanding jobs are at higher risk for back problems. Repetitive motions that involve lifting, pulling, or pushing objects, bending to the side, or twisting the body can also increase the risk of a herniated disc. Genetic. Some people inherit the predisposition to have a herniated disc. Smoke. Smoking is thought to decrease the oxygen supply to the discs and cause them to deteriorate faster. Frequent driving. Sitting for long periods of time, coupled with vehicle engine vibrations, can put stress on the spine. to be sedentary Regular exercise can help prevent a herniated disc.

Diagnostic

During the physical exam, the doctor will check if your back is tender. You may be asked to lie down and move your legs in various positions to determine the cause of the pain.

The doctor may also perform a neurological exam to assess the following: Reflexes Muscle strength Ability to walk Ability to feel light touch, pinpricks, or vibrations

In most cases of herniated disc, a physical exam and medical history are enough to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.

Imaging exams

X-rays. Plain X-rays don’t detect herniated discs, but they can rule out other causes of back pain, such as infection, tumor, spinal alignment problems, or a broken bone. CT. A CT scanner takes a series of x-rays from different directions and then combines them to create cross-sectional images of the spine and surrounding structures. Magnetic resonance. Radio waves and a strong magnetic field are used to create images of structures inside the body. This test can be used to confirm the location of the herniated disc and to see which nerves are affected. myelography. A contrast substance is injected into the cerebrospinal fluid before a CT scan is performed. This test can detect pressure on the spinal cord or nerves due to multiple herniated discs or other conditions.

neurological tests

Conservative treatment (mainly modifying activities to avoid painful movements and taking painkillers) relieves symptoms in most people within days or weeks.

Medications

Non-prescription painkillers. If the pain is mild to moderate, your doctor may recommend over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), or naproxen sodium (Aleve). Neuropathic drugs. These drugs act on nerve impulses to reduce pain. These include gabapentin (Gralise, Horizant, Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta, Drizalma Sprinkle), and venlafaxine (Effexor XR). Muscle relaxants. Muscle relaxants may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects. Opioids. Due to the side effects of opioids and the possibility of becoming addicted to them, many doctors are reluctant to prescribe them for a bulging disc. If other medications don’t relieve your pain, your doctor may consider short-term use of opioids, such as codeine or a combination of oxycodone and acetaminophen (Percocet, Oxycet). Sedation, nausea, confusion, and constipation are possible side effects of these medications. Cortisone injections. If the pain does not improve with oral medications, your doctor may recommend a corticosteroid which can be injected into the area around the spinal nerves. Spinal imaging tests can help guide the needle.

Therapy

Your doctor might suggest physical therapy for pain relief. Physical therapists can show you positions and exercises designed to minimize pain from a herniated disc.

Surgery

Few people with a herniated disc need surgery. Your doctor may suggest surgery if more invasive treatments fail to improve your symptoms after six weeks, especially if you continue to have: Poorly controlled pain Numbness or weakness Difficulty standing or walking Loss of bladder control or intestines

In almost all cases, surgeons can only remove the protruding part of the disc. In rare cases, the entire disc must be removed. In these cases, the vertebrae may need to be fused together with a bone graft.

To allow the process of bone fusion, which takes months, metal pieces are placed in the spine to provide stability to the spine. In rare cases, the surgeon may suggest the implantation of an artificial disc.