A herniated disc can be a common source of pain in the neck, back, arms, or legs. Often called a slipped or ruptured disc, a herniated disc is where the inner gel-like substance (nucleus) protrudes through the tough outer layers (annulus).
What are intervertebral discs?
Discs are rubbery, soft, quarter-sized pads between the vertebrae (bones that make up the spinal column). The spinal canal is a hollow space that contains the spinal cord and nerve roots. Discs allow forward and backward bedding of the spine and act as shock absorbers.
How common are herniated discs?
Intervertebral discs begin growing thinner and deteriorating around age 30. While 33% of adults over the age of 20 years have a herniated disc, only 3% of these cause symptoms. The highest prevalence of herniated disc occurs in people aged 30 to 50 years. Also, disc herniation occurs more often in men than women, and 95% of disc herniated in the lumbar (low back) region.
What symptoms are associated with a herniated disc?
When a person ages, the intervertebral discs loose water content and shrink. When this occurs, spinal stenosis can occur, which leads to sciatica. The symptoms of a low back (lumbar) herniated disc include back pain, shooting pain down the buttocks into the leg and or foot on the affected side, and electric shock sensations. With a neck (cervical) herniated disc, the patient may have pain of the neck as well as shooting pain down the arm on the affected side. Other symptoms are weakness in one leg or arm, a pins-and-needles sensation, tingling, or numbness in one leg or arm, and a burning pain centered in the neck or low back.
What causes a disc to herniate?
When the inner nucleus pushes through the outer layers, it can put pressure on the spinal nerves that exit the spinal cord. These nerves are quite sensitive to pressure, which causes numbness, weakness, and pain in an extremity.
Who is at risk for a herniated disc?
Conditions that can weaken a disc and make it at risk for herniation include:
- Improper lifting technique
- Sudden pressure
- Excessive body weight placing added stress on the disc
- Repetitive strenuous activities
How is a herniated disc diagnosed?
The doctor will ask you questions about your injury or trauma, inquire about your symptoms, take a medical history, and conduct a thorough medical examination. Because simple x-rays do not show a herniated disc, they are useful to assess the spinal column. The tests used to confirm a herniation are computed tomography (CT) and magnetic resonance imaging (MRI) scans.
How are herniated discs treated?
Nonsurgical treatment is effective for around 75% of patients. However, some people respond better to interventional measures. Treatment options include:
- Medications – These include muscle relaxers (Flexeril and Baclofen), anti-inflammatory agents (Naproxen and Ketoprofen), and analgesics (Tramadol and Hydrocodone).
- Physical therapy – The therapist will work with you to do exercises to strengthen the back and abdominal muscles. For the neck, traction may also be useful. Pain relief modalities include electrical stimulation, ultrasound, and heat therapy. In a randomized controlled trial, at 12-month follow-up, participants who were treated with physical therapy had more than a 50% reduction in pain and disability.
- Epidural steroid injection (ESI) – With this procedure, the doctor injects a corticosteroid agent, with or without an anesthetic, into the space around the spinal cord. In a recent clinical study, ESI had an 89% success rate for treating symptomatic lumbar herniated discs.
- Dekompressor discectomy – This procedure involves inserting a small needle and catheter into the disc to relief pressure and decompress the herniated disc. According to recent research studies, the procedure had a 92-98% efficacy rate.
- Surgery – While not commonly done, surgery may be required when a disc fragment lodges in the spinal canal. Surgical options include laminectomy and microdiscectomy, but the procedure depends on the size and position of the disc herniation.
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