Disc Herniation

Table of content

Introduction to Disc Herniation

Intervertebral Discs and their role

The spine is made up of bones (vertebrae), each one separated by a strong shock absorbing cushion called the intervertebral disc. The role of the disc is to act as an energy converter so as to transmit kinetic energy throughout the torso. This helps in the function of the spine to act as a rigid brace where the spine needs to be a stiff fulcrum but also where the spine needs to act as a coil thus increasing the power of the arms and legs.

There are 7 cervical (neck) vertebrae, 12 thoracic (chest) vertebrae, 5 lumbar (lower back) vertebrae, 5 sacral vertebrae and a coccyx. Disc herniations can appear at the cervical, thoracic and lumbar levels; lumbar and cervical spines are the most frequently affected.

The intervertebral disc is composed of a soft jelly-like material at its center, surrounded by a very resistant fibrous ring. This jelly is called nucleus pulposus and, when healthy, is generally soft. With aging, the nucleus begins to dehydrate and becomes dried out. At the same time, there can be cracks in the back part of the fibrous ring through which a jelly fragment can escape.

Herniated disc: axial and lateral

Causes of Disc Herniation

Disc degeneration results from the natural aging of intervertebral discs. It is a 'normal' process.

A disc herniation, sometimes referred to as a 'slipped disc' may be caused by:

  • genetics
  • physical factors

The average age for someone to get nerve pain in the leg, (sciatica) as a result of a disc herniation, is between 35 to 45 years. It appears to be less common with older people.

Sedentary occupations seem to be more at risk than jobs involving a lot of physical activity. Smoking, being overweight or obese and lack of fitness, appear to be contributing factors for a disc herniation.

Some studies show that more than 50% of the average population has a non-symptomatic herniated disc. The reasons why a disc herniation becomes symptomatic are not well known in most cases.

Conservative treatment will often result in improvement of the symptoms of a herniated disc, and the herniation will often reabsorb. Only a minority of patients (less than 5%) suffering from arm or leg pain due to disc herniation, will possibly need surgical treatment.

Diagnosis of Disc Herniation

Symptoms

Typically, a disc herniation provokes a chemical and mechanical irritation of the nearby nerve root. This can cause pain spreading to the front of the thigh, or pain in the buttock and in the back of the leg down to the foot (sciatica), depending on the exact nerve affected by the disc herniation.

The Importance of Seeking Medical Attention in Severe Cases

In a case of a slipped disc in the neck, the pain will spread along the arm. Any worsening symptoms of loss of bowel or bladder control, is considered severe and medical attention must be sought immediately.

Exams Conducted

The doctor will conduct a certain number of exams, which will determine if the pain is provoked by disc herniation such as:

  • MRI (Magnetic Resonance Imaging)
  • EMG (Electromyogram)
  • Nerve Conduction Studies may occasionally be done.

Treatment: Non-Surgical and Surgical Options Explained

Non-Surgical Treatment for Disc Herniation

Primary treatment is good pain control and the use of anti-inflammatory drugs, reassurance that the condition will probably resolve by itself and encouragement to return to normal activities as soon as possible. Some doctors recommend physiotherapy and/or manipulation therapy, as the muscle spasm and altered posture that accompanies a slipped disc may remain after the disc has settled. Thus, it is important to address posture and spinal alignment as the symptoms settle.

Surgical Treatment for Disc Herniation

If symptoms persist and are unacceptable to the patient, and in some cases where the disc herniation can provoke compression and irritation to the nerve roots causing severe pain and discomfort, surgery is required.

Surgery generally involves an incision in the front of the neck (for a cervical herniation) or in the back (for a lumbar herniation), and the herniated disc is then removed to release the compression on the nerve.

Patients are encouraged to get up and walk as soon as possible after the surgery. The duration of hospital stay depends on the facility and the country where the treatment is made. It is also recommended that patients resume their normal daily activities according to their doctors' advice.

EUROSPINE is a society of spine specialists of various disciplines with a large knowledge of spine pathologies. All well-known and accepted treatment modalities for spine pathologies are represented by the members of the society. However, the Society cannot accept any responsibility for the use of the information provided; the user and their health care professionals must retain responsibility for their health care management.