The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged, it may bulge or break open. This is called a herniated disc. It may also be called a slipped or ruptured disc.
You can have a herniated disc in any part of your spine. But most herniated discs affect the lower back (lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in the upper back (thoracic spine).Disc herniation is usually due to age-related degeneration of the anulusfibrosus, although trauma, lifting injuries, or straining have been implicated. Tears are almost always postero-lateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of inflammatory chemical mediators, which may directly cause severe pain, even in the absence of nerve root compression.Usually a herniated disc will heal on its own over time.
About half of people with a herniated disc get better within 1 month, and most are better within 6 months. Only about 1 person out of 10 eventually has surgery. A primary focus of surgery is to remove “pressure” or reduce mechanical compression on a neural element: either the spinal cord, or a nerve root. But it is increasingly recognized that back pain, rather than being solely due to compression, may also be due to chemical inflammation. This inflammatory molecule, called tumor necrosis factor-alpha (TNF), is released not only by the herniated disc, but also in cases of disc tear (annular tear), by facet joints, and in spinal stenosis.
Signs and symptoms
Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. Slipped Disk Symptoms. The nerves of the body exit the spine at each spinal level in the low back, mid back, and neck. A herniated disk can produce symptoms anywhere along the course of that nerve, though the injury and irritation of the nerve are at the spine itself. (This is known as referred pain, as the pain is “referred” from the source of the problem in the spine to the area supplied by the affected nerve.)
A slipped disk can produce varying degrees of pain in the back or neck along with numbness or weakness in the corresponding organs, arms, or legs as follows:
• For slipped disks in the neck: Neck symptoms and other associated symptoms include numbness, tingling, weakness, or pain in the shoulder, neck, arm, or hand. Symptoms of a herniated disk in the neck often increase or decrease with neck motion.
• For slipped disks in the lower back, back symptoms include
o Pain down the back of each leg from the buttocks to the knee or beyond (this is called sciatica, as it affects the sciatic nerve)
o Numbness, tingling, weakness, or pain in the buttocks, back, legs, or feet or all of these as in sciatica
o Numbness and tingling around the anus or genitals
o Pain with movement, straining, coughing, or doing leg raises
o Difficulty controlling bowel movements or bladder function
Most authors favor degeneration of the intervertebral disc as the major cause of spinal disc herniation and cite trauma as a low cause.
Disc degeneration occurs both with degenerative disc disease and aging.
Disc herniations can result from general wear and tear, such as when performing jobs that require constant sitting and squatting or driving (sedentary lifestyle). However, herniations often result from jobs that require liftingProfessional athletes, especially those playing contact sports, are prone to disc herniations.
Minor back pain and chronic back tiredness are indicators of general wear and tear that make one susceptible to herniation on the occurrence of a traumatic event, such as bending to pick up a pencil or falling.
When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc increases.
Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (anulusfibrosus) on the posterior side (back side) of the disc. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, which may produce intense and potentially disabling pain and other symptoms.
There is also a strong genetic component. Mutation in genes related to the lower back is also implicated.
Herniated lumbar disc.
Diagnosis is made by a practitioner based on the history, symptoms, and physical examination. At some point in the evaluation, tests may be performed to confirm or rule out other causes of symptoms such as spondylolisthesis, degeneration, tumors, metastases and space-occupying lesions, as well as to evaluate the efficacy of potential treatment options.
• Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, and surrounding areas.
• Computed tomography scan (CT scan): A diagnostic image created after a computer reads x-rays. However, visual confirmation of a disc herniation can be difficult with a CT.
• X-ray: Although traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, they are still used to confirm or exclude other possibilities such as tumors, infections, fractures, etc.
• Other test include; Myelogram, Electromyogram and Nerve conduction studies Prevention
• Protect your back when you lift. For example, lift with your legs, not your back. Don’t bend forward at the waist when you lift. Bend your knees, and squat. Education should emphasize not lifting beyond one’s capabilities and giving the body a rest after strenuous effort.
Over time, poor posture can cause the IVD to tear or become damaged.
Striving to maintain proper posture andalignmentwill aid in preventing disc degradation.
• Use good posture. When you stand or walk, keep your shoulders back and down, your chin back, and your belly in. This will help support your lower back.
• Get regular exercise. Exercises that are used to enhance back strength may also be used to prevent back injuries. Back exercises include the prone press-ups, transverse abdominus bracing, and floor bridges. If pain is present in the back, it can mean that the stabilization muscles of the back are weak and a person needs to train the trunk musculature.
• Stay at a healthy weight. This may reduce the load on your lower back.Do not work oneself past fatigue. Signs of fatigue include shaking, poor coordination, muscle burning and loss of the transverse abdominal brace. Individuals who engage in power lifting place their bodies under heavy stress.
• Don’t smoke. Smoking increases the risk of a disc injury.
In the majority of cases, spinal disc herniation doesn’t require surgery. Minor cases can be handled at home in consultation with your doctor. Treatment at home will likely include application of hot or
cold packs, limited activity (although strict bed rest is not generally advised), and basic pain relievers such as acetaminophen or ibuprofen. As your condition improves, specific neck or back stretching or strengthening exercises may be suggested Initial treatment usually consists of non-steroidal anti-inflammatory pain medication (NSAIDs), but the long-term use of NSAIDs for people with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity. Other analgesics and smooth muscle relaxant can be employed.
The doctor often prescribes rest or limited activity for several days followed by gradual increase in activity over the next few weeks.
Strict bed rest is generally not advised because people with back pain have been shown to recover more quickly with normal activity as long as lifting, bending, and straining are limited.
Treat with ice or cold packs early after an injury and switch to heat later. Heat may be used early if the pain and symptoms are not caused by a sudden injury.
Physical therapy, exercise, and massage can be helpful if indicated (always check with your doctor before resuming any stressful activity).
Surgery may be useful in those with a herniated disc that is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control. Discectomy (the partial removal of a disc that is causing leg pain) can provide pain relief sooner than nonsurgical treatments. Discectomy has better outcomes at one year but not at four to ten years.
Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation.
The former is the most common, causing lower back pain (lumbago) and often leg pain as well, in which case it is commonly referred to as sciatica. Lumbar disc herniation occurs 15 times more often than
cervical (neck) disc herniation, and it is one of the most common causes of lower back pain.