The spine is built from a column of vertebrae (bone of the spine) that are separated by discs of soft, rubbery tissue that are known as intervertebral discs. These discs play an important role: they serve as shock absorbers for the spine, and allow the vertebral bodies to smoothly glide along each other, providing the freedom of movement to flex, bend, or twist the spine.
Intervertebral discs have two main parts: a thick, tough, outer layer of cartilage that is called the annulus fibrosus; and, a soft, gelatinous inner substance that is called the nucleus pulposus. The spinal column also provides space for important structures, such as the spinal cord and the spinal nerve roots, arteries, and serves as an attachment for muscles, ligaments and other tissues.
Disc herniation refers to the condition where the central nucleus pulposus extrudes through a weak point in the annulus fibrosus. The extruded portion then compresses the spinal cord and nerve roots, causing symptoms of pain, and in some cases, reduced sensation and motor weakness.
The presentation of symptoms varies depending on the level of the disc herniation, as well as the severity of the herniation. Pain can range from a mild irritiation, to a severe shooting pain that interferes with daily activities.
The compression of the nerves can also cause motor limb weakness, and decreased reflexes. Some case reports have also noted that disc herniation causes visceral pain. While it is possible that herniated discs will heal on their own, most cases require the examination and treatment from a Boulder pain management doctor.
There is no single identified cause of disc herniation, although most cases are thought to result from the generalized wear and tear of the annulus fibrosus. Aging also plays an important factor, as the strength of the annulus fibrosus has been noted to decrease with age.
Occupation and lifestyle are also noted to be important risk factors: jobs that require constant sitting and squatting, lifting and pressure on the spinal column have been noted to be more at risk for disc herniation. Excessive body weight and smoking have also been noted to be risk factors for this condition.
The conservative, nonsurgical treatment has been shown to improve symptoms in more than 90% of patients. This involves the prescription of medications for pain relief, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The relief of pain is important for most patients, and allows the initiation of a physical therapy and rehabilitation program.
Physical therapy to improve posture, as well as to strengthen and condition the back muscles, has been shown to provide significant improvements. Epidural and steroid injections have also been shown to be effective in reducing pain symptoms, and improving functionality in patients.
Surgical intervention is still the definitive treatment for disc herniation, although this is typically reserved for the more severe cases, as well as for when the more conservative treatment options have already failed. However, surgery carries with it risks, such as infection, intraoperative damage, and bleeding and hematoma at the surgical site.