Having a herniated disc is a surprisingly common problem in the United States. Along with other back injuries such as strains and sprains, herniated discs account for almost 20% of all workplace injuries. The good news is that there are many different ways to get treatment for this kind of disc problem.
What does the spine do?
To understand a herniated disc, it’s helpful to know a bit about the spine and the purpose it serves. At a basic level, the spine (also technically referred to as the vertebral column) has three main functions: to protect the spinal cord, to provide structural support to the skeleton, and to enable flexible motion. The spine is naturally a crucial part of human skeletal strength and is indeed the defining characteristic of vertebrates, the subphylum humans share will all living creatures that have a spine.
The spine is composed of thirty-three vertebrae which are categorized into four groups: cervical, thoracic, lumbar, and sacral. The vertebrae in these regions protect various vital parts of the brainstem and spinal cord as well as allowing for flexion and rotational movement. Each vertebra is a structure made up of bone and cartilage, and they are stacked on top of each other to form the vertebral column.
Between each vertebra, on the top and bottom, is an intervertebral disc, also referred to as intervertebral fibrocartilage. A disc is composed of an outer ring of fibrous material (annulus fibrosus disci intervertebralis) and a gel-like center (nucleus pulposus). Together, the firm yet flexible materials allow the discs to function as ligaments for the vertebrae; in addition to allowing flexible movement, the discs work as shock absorbers for the entire spine.
What is a herniated disc?
A herniated disc refers to a situation where the cushiony material of an intervertebral disc is damaged in some way. The discs are typically very tough and able to withstand a significant amount of strain, but sometimes strain or injury is severe enough to cause a tear in the fibrous outer ring of the intervertebral disc. When this happens, the soft, gel-like center can leak out and bulge passed the outer ring. A disc in these circumstances is considered to be herniated, a word which basically means “to protrude.”
The symptoms which accompany a herniated disc vary depending on the amount of herniation and the position of the disc in relation to the rest of the spinal column. The vast majority of cases happen in either the lumbar or cervical regions of the spine, in large part because the thoracic region is the least mobile and the vertebrae of the sacral region are fused (and thus totally immobile). In some cases, if the herniated disc isn’t directly pressing on a nerve, the person may feel no symptoms at all. Otherwise, here are some of the most common symptoms, usually experienced on one side of the body or the other:
- Lumbar spine
- Leg pain
- Foot pain
- Burning sensation
- Weakness in the toes or feet (known as foot drop)
- Numbness or tingling in the feet
- Radiating pain from the buttocks down to the leg
- Cervical spine
- Neck pain
- Pain between the shoulder blades
- Pain that radiates down the arm to the hands and fingers
- Numbness or tingling in the shoulders or arms
What causes a herniated disc?
A herniated disc is often caused by trauma or excessive strain. An illustration: when a person is standing up straight or lying down, the pressure on each disc is essentially equal, but when bending over to lift something, for instance, there can be a great shift in pressure from one side of a disc to another. Even a single instance of this kind of strain can rupture the outer ring of an intervertebral disc and cause a herniation. It is thought that regular instances of this kind of strain may make it more likely for a disc to become herniated.
There is some dispute amongst doctors and scientists about the most common cause. Many cite trauma or strain, but there are others who look to age-related reasons. As a person ages, the intervertebral discs, like many other parts of the body, begin to gradually degenerate through “wear and tear.” This can happen alongside simple aging, or it can happen as a result of degenerative disc disease, a chronic condition that involves the degeneration of discs due to the loss of soluble proteins in the fluid of the nucleus pulposus.
Another piece of evidence that supports the idea of aging as a cause is a fact that young people very rarely get herniated discs. It is most common in adults aged 35-55. In addition to decades of upright posture and lifting objects leading to degeneration, there also may be genetic factors at play; there is evidence that people with family members who have had a herniated disc are more likely to have it happen to them. Overall, about 2% of the population suffers from a herniated disc, and it is about twice as likely to be a man than a woman.
To treat a herniated disc, doctors have a variety of treatments available. Treatment usually starts with a conservative, non-surgical approach, and it is effective for many people; in fact, in one study, one-third of patients show significant improvement within two weeks. This kind of treatment includes lowering activity levels, taking non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain, and potentially physical therapy to rebuild strength and flexibility. In cases of more extreme pain, the doctor may use a steroid injection directly into the disc.
If more conservative treatment options are unsuccessful, the doctor may turn to surgery to bring the patient lasting relief. They typically will recommend surgery if the pain limits or impairs quality of life or normal activities; surgery may also be recommended if neurological symptoms progress to include difficulty standing or walking or a loss of bladder and bowel functions. If surgery becomes necessary, there are two main routes, depending on the location of the herniated disc:
Lumbar Spine Surgery: This surgery is generally used to relieve the kind of leg pain associated with a herniated disc in the lumbar region of the spine. In the procedure, a small incision is made down the center of the back in the area of the herniation and the disc in question is removed. Depending on a variety of factors, the doctor may fuse the vertebrae in order to prevent movement or an artificial disc may be implanted.
Cervical Spine Surgery: Cervical spine surgery is very similar to lumbar surgery, but it involves the vertebrae of the cervical region of the spine. A small incision is also used in order to remove the damaged disc. Many patients don’t need to have the remaining vertebrae fused, but fusion and artificial disc replacement are both options.
In more recent years, the risks associated with this kind of surgery have led doctors to develop minimally invasive surgical options. In these procedures, rather than opening up the spinal cavity to remove the disc, it can be done laparoscopically. Both the potential surgical trauma and postoperative recovery are significantly lessened.
When to See a Doctor Many people often choose to “tough it out” when they have back pains or any other seemingly minor aches or pains. For some people, though, the pain can become a nuisance or even start to impact their daily lives. If this is you, or if you have more extreme symptoms like loss of bladder control or balance, it’s time to see a spine doctor. Contact NewSouth NeuroSpine today to make an appointment.