What is a Herniated Disc?
A spinal disc herniation, informally and misleadingly called a “slipped disc”, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to leak out.
The spine is composed of 23 vertebral discs. 6 are in the neck (cervical region), 12 are in the middle back (thoracic region), and 5 are in the lower back (lumbar region). These discs act as shock absorbers for the spine which endures tremendous pressure on a daily basis. As described above, a herniated disc occurs when one of these discs tears and the center of the disc leaks out.
Tears are almost always postero-lateral (located toward the back) in nature owing to the presence of the slightly weaker 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. This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.
A herniated disc is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure. This can occur in the cervical, thoracic and lumbar spine and are most commonly caused by aging or acute injury.
What are the Symptoms of a Herniated Disc?
The most common symptom of a herniated disc is pain. For others, a herniated disc may cause no symptoms. For the patients who do feel pain, the top complaints are numbness, weakness, muscle spasms, tingling, pins and needles, burning, stiffness, and sharp, radiating or dull pain. The symptoms of a herniated disc correlate to the location of the injury. For example, a slipped disc in the cervical spine may cause pain in the neck and arms, whereas a herniation in the lower spine causes lower back discomfort or pain in the lower extremities.
Herniated Disc Symptoms Include:
- Radiating Pain
- Sharp Pain
- Tingling or Numbness
- Sciatic Pain
- Neurological Symptoms
- Burning Sensation
- Muscle Spasms
What Causes a Herniated Disc?
Herniated Discs are most often caused by the natural aging process and usually occur in middle-aged people. The vertebral discs in the spine are made-up almost entirely of water. Gradually as we age, normal wear-and-tear from movement, posture and other daily activities causes the discs to lose water making them less resilient. This weakening in the disc can lead to tear or rupture.
A traumatic event, such as car accident or sports injury, is another common source of a slipped disc. Heavy lifting and repetitive motion are also frequent causes. Other typical causes of pinched nerves are:
- Natural Aging
- Acute Injury
- Repetitive Motion
- Degenerative Disc Disease
- Poor Posture
- Poor Health or Obesity
- Improper Lifting and Twisting
- Repetitive Motion or Overuse
Where can a herniated disc be located?
Herniated Disc in the Lumbar Spine: The lumbar discs are more susceptible to herniation than the cervical and thoracic intervertebral discs because they act as the body's main shock absorbers. They are also the most common cause of sciatica due to the proximity of the sciatic nerve.
Patients often complain of:
- Sharp pain or soreness in the lower back
- Radiating pain that travels down the leg, sometimes into the foot
- Stiffness in the back
- Weakness in the leg or foot
- Tingling pain or pins and needles
- Burning pain
- Discomfort while sitting or standing
- Interruption in sleep because of pain
- Drop foot or difficulty lifting foot
Herniated Disc in the Cervical Spine: Neck pain is extremely common and sometimes that pain is caused by a slipped disc. Whiplash from a car accident is a common cause of cervical disc herniation. A herniated disc in the cervical spine is characterized by:
- Sharp pain or soreness in the neck or shoulders
- Radiating pain that travels into the arms or hands
- Aching or burning pain
- Feeling of pins and needles in the arms
- Pain when you turn your head
- Headaches or pressure at the base of the skull
Herniated Disc in the Thoracic Spine: A herniated disc in the thoracic spine is the most uncommon and usually caused by acute injury or accident.
Patients often complain of:
- Pain in the mid-back
- Pain between the shoulders
- Chest pain
- Shortness of breath
- Tingling or pins and needles
- Weakness in the mid back
- Sharp pain or aching
- Pain while coughing or sneezing
How is a herniated disc diagnosed?
After a complete medical history review and clinical examination, patients suffering from symptoms associated with a herniated disc are often sent for imaging. An MRI, CT scan and X-ray are the most common imaging tests used to diagnose a slipped disc.
How is a herniated disc treated?
Treatment for a herniated disc depends on the pain associated with the problem. Many people who suffer from slipped discs experience mild to no side-effects at all. Patients who do experience pain or discomfort are often prescribed conservative care and rest. Rest take the pressure off the spine and helps the disc to heal naturally. Conservative care treatments for herniated discs are as follows:
- Heat and Ice
- Physical Therapy
- Chiropractic Care
- Epidural Steroid Injections
- OTC Medication such as ibuprofen to reduce inflammation
- Muscle Relaxants to calm muscle spasms
- Narcotics or Opioids short term as they can be habit forming and lose effectiveness over time as patient develops tolerance.