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Home >> Spine Problems >> Herniated Disc

Herniated Disc

The outer layer of the disc cracks, and the gel-like center emerges, causing the disc to protrude and place pressure on the nerve that stems from the spine in that particular spot.

Overview

Many vertebrae layered on top of each other comprise the spine. Between these bones are discs, which serve as shock absorbers. The shock-absorbing discs resemble jelly donuts, each having a jelly-like center. With age, the discs naturally become less flexible and more brittle. Normal disc degeneration naturally occurs with old age and may also be painful.

select image to enlarge herniated disc diagram

select image to enlarge bulging disc diagram

Discs can herniate in any direction--forward, centrally or, most commonly, backward and sideways in the direction of the spinal nerves.

Herniated discs account for a small percentage of back pain.
While discs do not slip out of position, herniated discs are often referred to as “slipped discs”. Discs are attached by connective tissue to vertebrae above and below. A “contained” herniated disc means the jelly center remains within the disc wall but a bulge exists. With an "uncontained" herniation the jelly center has broken through the annulus wall but stays connected to the nucleus pulposus. Or the herniation can be “sequestered,” when it breaks free from the nucleus and travels away from the disc.

A bulging disc forms when the wall of the disc is deformed but not necessarily herniated. The nucleus is still contained in the wall. Surgery is not necessary to treat a bulging disc.

Causes

Common causes of disc herniation can include heavy lifting or tripping and falling. Discs can rupture, causing the nucleus to break through the wall of the disc and place pressure on the nerves that branch out from the spinal cord. A herniated disc accompanied by back or neck pain may result.

Symptoms

People may mistake excruciating pain for a herniated disc, however the pain might actually be the signal of a muscle strain.

Because the nerve roots act as telegraph lines to other parts of the body, a common difficulty of disc herniation is that pain may also be felt in other parts of the body. In fact, leg pain below the knee is a common herniated disc symptom. This radiating pain is called radicular pain or radiculopathy. Often, back pain without leg pain can be a result of partial herniation of the disc or an internal disc disruption.

Diagnosis

Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

Medical history:

Performing a detailed medical history allows the doctor improved understanding of the possible causes of your back and neck pain. Moreover, this knowledge may help outline the most appropriate treatment.

Physical exam:

The physical exam is helpful in allowing your physician to isolate the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
X-rays are usually the initial step in diagnostic testing methods. While x-rays show bones and the space between bones, they are of limited value because they do not show muscles and ligaments.

MRI (magnetic resonance imaging):

Involves magnetic field and radio waves to produce highly detailed pictures of the inside of your body. As x-rays only show bones, MRIs are necessary to envision soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.

CT scan/myelogram:

Comparable to an MRI, a CT scan provides diagnostic information about the internal structures of the spine. A myelogram is engaged to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems exist.

Electrodiagnostics:

As part of a diagnostic workup, electrical testing of the nerves and spinal cord may be performed. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), help your doctor understand how your nerves or spinal cord are affected by your condition.

Bone scan:

In an effort to detect infection, malignancy, fractures and arthritis in any part of the skeleton, bone imaging is used. Bone scans are also helpful in locating lesions for biopsy or excision.

Discography:

Used to determine the internal structure of a disc. It is performed via local anesthetic and by injecting a dye into the disc under X-ray guidance. Both X-ray and CT scan are performed to establish whether disc composition is normal or abnormal. Additionally, your doctor will note any pain associated with this injection. The benefit of a discography is that it enables the physician to verify the disc level that is causing your pain. This exam helps reduces the risk of operating on the wrong disc as well as ensures surgery will be more successful.

Injections:

Pain-relieving injections help relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.

Treatment

Unfortunately, while muscles can heal somewhat quickly, a torn or degenerated disc heals more slowly. On a more positive note, in many cases the pain and inflammation originating from damaged discs may be treated nonsurgically. Reducing the inflammation and strengthening the musculature surrounding the damaged disc to increase support is a nonsurgical method.

Special extension exercises can help relieve pain from a herniated disc. Exercise can work like a vacuum to suck the center of the disc back into place, helping release pressure on the nerve. It may surprise back pain sufferers to learn that specific exercises can help relieve their pain.

FAQ

What caused my disc to herniate?

Herniated discs may occur as a result of a heavy strain or fall, which causes the nucleus to break through the wall of the disc and place pressure on the nerves that branch out from the spinal cord. An example, lifting a heavy object after sitting down for a long period of time can cause a disc to herniate.

What is the best way to treat a herniated disc?

Nonsurgical treatment methods are always the best first option. This will most likely involve working with a physical therapist. Your PT will help develop a customized exercise program that involves specific stretches and extension movements for you.