Herniated Disc – Causes, Types and Treatment

Overview

Herniated disc, often referred to as a slipped disc or ruptured disc, is a common spinal condition that can cause discomfort and pain. It occurs when the outer layer of a spinal disc, which acts as a cushion between the vertebrae, weakens or tears, allowing the inner gel-like material to protrude outward. This protrusion can put pressure on nearby nerves, leading to symptoms such as pain, numbness, tingling, or weakness. It is most commonly occur in the lower back (lumbar spine) or the neck (cervical spine), but they can occur in any part of the spine. The condition can result from various factors, including age-related degeneration, injury, or excessive strain on the spine.

Individuals with a herniated disc often experience varying degrees of discomfort depending on the location and severity of the herniation. While some cases may be relatively mild and improve with time and conservative measures, others can lead to more persistent and debilitating symptoms. Diagnosis typically involves a combination of physical examination, medical history assessment, and imaging tests such as MRI or CT scans. Understanding the underlying causes and symptoms of a herniated disc can help individuals make informed decisions about managing their condition and seeking appropriate medical guidance.

Anatomy of discs

Your spine consists of 24 mobile bones referred to as vertebrae. The lumbar portion, which is the lower back, shoulders the majority of the body’s weight. This area encompasses 5 lumbar vertebrae, named from L1 to L5. The vertebrae are divided by soft discs, serving as shock absorbers that prevent friction between the vertebrae. These discs possess an outer ring known as the annulus, featuring fibrous bands attaching to each vertebra’s bodies. Each disc includes a nucleus at its center, filled with a gel-like substance. At every disc level, a duo of spinal nerves emerges from the spinal cord, branching out to various parts of the body. The spinal cord and spinal nerves act akin to a “telephone,” facilitating the transmission of messages or impulses between the brain and body, enabling the relay of sensations and the control of movement.

Epidemiology

Herniated disc occurrences affect roughly 5 to 20 individuals out of every 1000 adults each year. This condition is most commonly observed in individuals between their third and fifth decades of life, with a ratio of 2 males to 1 female. The estimated occurrence rate of symptomatic herniated discs in the lumbar spine is approximately 1-3 percent among patients. This prevalence is notably higher within the 30-50 age bracket. Individuals aged between 25 and 55 carry an approximate 95 percent likelihood of experiencing herniated discs, primarily at the L4-L5 or L5-S1 levels. Disc-related ailments contribute to the underlying cause of back pain in fewer than 5 percent of patients.

Pathophysiology of Herniated discs

The pathophysiology of a herniated disc involves a sequence of events within the intervertebral disc that leads to its protrusion and subsequent effects. It typically begins with the degeneration of the disc’s outer layer, the annulus fibrosus, due to factors like age-related wear and tear or injury. As this outer layer weakens, it may develop small tears or fissures.

The nucleus pulposus, the gel-like core of the disc, can then exert pressure against the weakened annulus fibrosus. In cases of herniation, the nucleus pulposus can force its way through these weak points in the annulus, resulting in a protrusion of disc material. This protrusion can take different forms: it may remain contained within the annulus (protrusion), or it may breach the annulus and extend into the spinal canal or surrounding tissues (extrusion). The protruded or extruded disc material can potentially compress spinal nerves, leading to various symptoms such as localized pain, radiating pain, numbness, tingling, or muscle weakness. The body’s inflammatory response to this compression can further contribute to pain and discomfort associated with herniated discs.

Types of herniated discs

It is also known as slipped discs or ruptured discs, can be categorized into different types based on their location and the direction in which the disc material protrudes. The two primary types are:

Protrusion (contained disc herniation)

In this type of herniation, the inner core of the disc (nucleus pulposus) pushes against the outer disc wall (annulus fibrosus), causing the disc to bulge outward. The outer layer of the disc is still intact, containing the protruding material within the disc. This type of herniation may or may not cause symptoms, depending on whether the bulging disc material presses against nearby nerves.

Extrusion (non-contained disc herniation)

Extrusion occurs when the inner core of the disc breaks through the outer disc wall and extends into the spinal canal or into the surrounding area. In this case, the disc material is no longer completely contained within the disc itself. Extruded disc material can put pressure on spinal nerves, leading to symptoms such as pain, numbness, tingling, or weakness in the affected area. The severity of symptoms can vary based on the size and location of the extruded material.

It’s important to note that the distinction between these types of herniated discs helps healthcare professionals determine the appropriate course of treatment. While some herniated discs may resolve with conservative measures, others may require more specialized interventions. Additionally, the location of the herniation (cervical, thoracic, or lumbar spine) can further impact the specific symptoms and treatment options.

Causes of herniated disc

It is also known as slipped discs or ruptured discs, can be caused by a combination of factors that affect the integrity of the intervertebral discs in the spine. Some common causes include:

1. Age-related degeneration: As people age, the intervertebral discs naturally lose water content and elasticity, making them more prone to wear and tear. This degeneration weakens the outer disc wall (annulus fibrosus), increasing the risk of herniation.
2. Excessive strain: Repetitive lifting, bending, or twisting motions, especially when done with poor body mechanics, can put excessive pressure on the discs and gradually lead to damage or herniation.
3. Trauma or injury: Sudden impact or trauma, such as a fall or car accident, can cause the discs to herniate. The force from the impact can weaken the disc’s outer layer, allowing the inner material to push through.
4. Genetic factors: Some individuals may be genetically predisposed to weaker intervertebral discs, making them more susceptible to herniation, even without significant trauma or strain.
5. Smoking: Smoking has been linked to decreased blood flow to the spinal discs, which can hinder their ability to heal and regenerate, increasing the risk of herniation.
6. Obesity: Excess body weight can increase the load on the spine, putting more pressure on the discs and increasing the risk of disc degeneration and herniation.
7. Occupational factors: Jobs that involve heavy lifting, repetitive movements, or prolonged sitting can contribute to the development of herniated discs, especially if proper ergonomics are not maintained.
8. Weak core muscles: Poor muscle strength and stability in the core and back muscles can lead to improper spinal alignment, making the discs more susceptible to herniation.
9. Degenerative disc disease: This chronic condition involves the gradual breakdown of spinal discs over time, which can contribute to the development of herniated discs.
10. Inflammatory conditions: Certain inflammatory conditions, such as an autoimmune disorder like ankylosing spondylitis, can increase the risk of disc herniation due to inflammation and structural changes in the spine.

It’s important to note that while these factors can increase the risk of herniated discs, not everyone with these risk factors will develop the condition. Maintaining a healthy lifestyle, practicing proper body mechanics, and taking preventive measures can help reduce the likelihood of herniated discs.

Signs and Symptoms

In most cases, low back pain is the first symptom. This pain may last for a few days, then improve. Other symptoms may include:

• Sciatica. This is a sharp, often shooting pain that extends from the buttock down the back of one leg. It is caused by pressure on the spinal nerve.
• Numbness or a tingling sensation in the leg and/or foot
• Weakness in the leg and/or foot
• Loss of bladder or bowel control. This is extremely rare and may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.

Complications of Herniated Disc

It can lead to several complications, including:

• Pain and Discomfort: Herniated discs often cause pain in the back or neck that can spread to the arms or legs, making everyday activities challenging.
• Nerve Compression: The protruding disc material can press on spinal nerves, leading to numbness, tingling, or weakness in the areas served by those nerves.
• Sciatica: When a herniated disc presses on the sciatic nerve, it can cause intense pain that radiates down the buttocks and legs.
• Loss of Function: Severe cases of herniation might lead to muscle weakness and difficulty controlling limbs due to nerve compression.
• Bowel or Bladder Issues: In rare instances of extreme nerve pressure, herniated discs can affect bowel or bladder control, requiring immediate medical attention.
• Permanent Nerve Damage: If not managed, long-term nerve compression can result in permanent nerve damage and chronic pain.
• Reduced Quality of Life: Chronic pain and limitations in movement can impact daily life, causing emotional distress and affecting overall well-being.

Prompt medical evaluation and appropriate treatment can help manage complications and prevent further deterioration.

Risk Factors

Factors that can increase the risk include:

• Weight. Excess body weight causes extra stress on the discs in the lower back.
• Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also can increase the risk of a herniated disc.
• Genetics. Some people inherit a predisposition to developing a herniated disc.
• Smoking. It’s thought that smoking lessens the oxygen supply to disc, causing them to break down more quickly.
• Frequent driving. Being seated for long periods combined with the vibration from the motor vehicle engine can put pressure on the spine.
• Being sedentary. Regular exercise can help prevent a herniated disc.

How to diagnosis herniated disc?

In addition to a complete medical history and physical exam, you may have one or more of the following tests:

• X-ray. A test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Magnetic resonance imaging (MRI). A procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.
• Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• Electromyography (EMG). A test that measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle.

Treatment for Herniated Disc

You may need more advanced treatments if your symptoms aren’t getting better. Your healthcare provider might recommend:

• Medication: Your provider may prescribe an anti-inflammatory pain reliever or muscle relaxant.
• Physical therapy: A physical therapist teaches you an exercise program to help relieve pressure on your nerves. Exercise loosens tight muscles and improves circulation.
• Spinal injections: Called an epidural or nerve block, a spinal injection is a shot of steroid medication directly into your spine. The medication reduces swelling and inflammation of the nerve from the disc herniation. This will allow your body to heal and return to activity faster.
• Surgery: In rare cases, a large herniated disc might injure nerves to the bladder or bowel. That may require emergency surgery. For nonemergency cases, surgery is an option when other treatments fail. There are various ways to perform spinal decompression surgery, but the goal is to relieve pressure on the nerve.

Is surgery required for Herniated discs?

It get better on their own over time or with nonsurgical treatment for 9 out of 10 people. If other treatments don’t relieve your symptoms, your healthcare provider may recommend surgery. There are multiple surgical techniques for relieving pressure on the spinal cord and nerves, including:

• Discectomy to remove your herniated disc.
• Laminectomy to remove part of the bone around a herniated disc and expand your spinal canal.
• Artificial disc surgery to replace a damaged herniated disc with an artificial one.
• Spinal fusion to directly join two or more vertebrae together to make your spine more stable.

Home treatment

You can practice good home care to treat your disc, as well. Good posture can help your back by reducing the pressure on your disc. Focus on standing up straight, sitting straight, and lifting with your back straight. Follow these tips to do what you can on your own to ease your symptoms:

• Bend your knees and hips and keep your back straight when you lift something.
• Hold an object close to your body when you carry it.
• If you stand for a long time, put one foot on a small stool or box for a while.
• If you sit for a long time, put your feet on a small stool so your knees are higher than your hips.
• Don’t wear high-heeled shoes.

Prevention of Herniated Disc

Back pain affects 8 of 10 people at some time in their lives, and usually resolves within 6 weeks. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If your regular job cannot be done initially, it is in the patient’s best interest to return to some kind of modified (light or restricted) duty. Your physician can give prescriptions for such activity for limited periods of time.

The key to avoiding recurrence is prevention:

• Proper lifting techniques
• Good posture during sitting, standing, moving, and sleeping
• Appropriate exercise program to strengthen weak abdominal muscles and prevent re-injury
• An ergonomic work area
• Healthy weight and lean body mass
• A positive attitude and stress management
• No smoking