Disc Herniation: Causes, Symptoms, Diagnosis, and Treatment

What Is Disc Herniation?

The bones that form the spine in the back are said to be vertebrae. These vertebrae in the spine are cushioned by discs. The discs are small pillow-like round structures that contain an annulus (outer layer) that surrounds the nucleus. The discs are located between the vertebrae in the spinal cord. It acts as a shock absorber of the vertebrae. The herniation of the disc happens when the disc slips off from its normal position that is it happens when the fragment of the disc nucleus is pushed out from the annulus into the spinal canal due to rupture or tear in the annulus. The herniated disc will be in the early stage of degeneration. As there is inadequate space for the spinal nerves and herniated disc in the spinal cord, the herniated disc press the spinal nerves which results in severe pain, weakness, and numbness of the back region. Disc herniation can occur at any part of the spinal cord. It is more common in the lumbar spine (lower back) and cervical spine (neck).

What Causes Disc Herniation?

Herniation of the disc happens when the nucleus of the disc slips out due to a crack in the fibrous lining of the disc. It is most common in the lower back and neck region, and less common in the middle back region. The common symptoms of disc herniation include:

• Aging.

• Repeated movements over time.

• Overuse.

• Gradual wear.

• Excessive weight.

• Improper lifting or twisting.

• Some medical problems such as spinal stenosis and connective tissue diseases.

What Are the Symptoms of Disc Herniation?

The slipped disc releases chemicals that irritate the surrounding structures which in turn cause pain and inflammation. A herniated disc also causes pain by compressing the spinal nerves. Some people will not experience any symptoms when the disc gets herniated. But some of the common symptoms are:

• Muscle weakness happens when the herniated disc press the spinal nerves. The muscles connected to the nerves get weak which in turn causes stumbling while walking.

• Tingling or numbness can also happen due to the pressing of spinal nerves. When the herniated disc press the spinal nerves it causes some unusual sensation in the arms or legs.

• A herniated disc may cause sharp pain in the lower back region that can radiate to the arms or legs.

Symptoms of a herniated disc can vary to their location. In severe cases, it causes pain along with problems in bladder or bowel control.

Lumbar Region (Lower Back) -

If the disc is herniated in the lumbar region the person may experience pain in the thighs, buttocks, and calves. Usually, the pain travels in the path of the sciatic nerve from the buttocks to the legs which is known as sciatica.

Cervical Region (Neck) -

If the disc is herniated in the cervical region the person may experience pain in the neck, shoulders, and arms. In severe cases, the person may also experience stiffness, numbness, and weakness in the legs.

Thoracic Region (Middle Back) -

If the disc is herniated in the thoracic region the person may experience pain in the areas around the herniation. The pain can travel around the rib cage and in front of the body.

How Is Disc Herniation Diagnosed?

The diagnostic procedures include:

• Medical History - The healthcare providers take patients' medical history to rule out the location and duration of pain.

• Physical Examination - Healthcare providers perform physical tests to assess pain, sensation, muscle strength, range of motion, walking ability, sensitivity to touch, and muscle reflexes.

• MRI (Magnetic Resonance Imaging) - It is an imaging test that accurately diagnoses disc herniation.

• CT (Computed Tomography) - In CT scan the healthcare provider can observe vertebrae of the spinal cord and diagnose the disc herniation.

• X-rays - It may be helpful to locate the herniated disc.

• EMG (Electromyograms) - It is done by involving small needles in the various muscles to evaluate the function of the nerves. It helps to find which nerve is affected by the herniated disc.

• Myelogram - It is done by injecting due into the spinal cord with the guidance of X-rays. The injected dye can reveal the spinal canal and the location of the disc herniation.

How Is a Disc Herniation Treated?

In most cases, disc herniation heals on its own but it takes up to 12 weeks. Usually, most people treat it by avoiding the triggering movements and pain management and exercise procedure as recommended by their doctors. The treatments for disc herniation include

Medications

• Muscle Relaxants - These muscle relaxants help to relax the painful muscles but the major disadvantage is that they can cause fatigue and other serious side effects.

• Over-The-Counter Medications - The pain can be reduced using NSAIDs (non-steroidal anti-inflammatory drugs) such as Naproxen and Ibuprofen.

• Nerve Pain Medications - If the symptoms persist for a longer time the doctors may prescribe anticonvulsant drugs such as Gabapentin. This medication may also cause side effects like drowsiness.

• Opioids - If the pain is not relieved by over-the-counter drugs then healthcare providers may suggest using opioid medications.

Physiotherapy -

Physical therapists treat persons with disc herniation by recommending some exercises and positions that can minimize the pain. As in most cases disc herniation heals on its own doctors usually recommend physical therapy until the symptoms persist after 3 weeks.

Injections -

Healthcare providers treat disc herniation with nerve block injections. The injection procedures may be spinal nerve injections and epidural injections.

Surgical Treatment -

If the disc herniation cause stiffness, muscle weakness, mobility problems, and problems with bladder or bowel control, the doctors may recommend surgical treatments. The surgical treatments for disc herniation include:

• Discectomy.

• Laminectomy.

• Nucleotomy.

• Disc replacement.

• Spinal fusion.

What Are the Complications of Disc Herniation?

The disc herniation can cause compression in cauda equina (which is described as the group of individual nerves that separates the spinal cord). This cauda equina is also called a horse's tail. This compression of cauda equina is called cauda equina syndrome (CES). This syndrome causes permanent paralysis of limbs, weakness, loss of bladder and bowel control, and sexual dysfunction. It is treated by emergency surgical procedures.

Conclusion

Disc herniation can be prevented by learning proper techniques for handling and lifting heavy objects, avoiding movements that trigger pain, managing weight, and quitting smoking in a person who has the habit of smoking. Taking the right treatment at the right time with the healthcare providers helps in reducing the severity of the condition.