Living with a ruptured, or herniated, disc can be an extremely painful and debilitating experience. It can impair your ability to perform even the most basic physical tasks, such as bending over or walking. Even something simple like crawling out of bed can be a daunting task. According to the National Center for Biotechnology Information (NCBI), this condition can occur at any age but is most common in people between the ages of 30-50 years old with a male to female ratio of 2:1. Most pain associated with a herniated disc often occurs in the upper cervical and lower lumbar regions of the spine.
Symptoms of a herniated disc can range from no symptoms at all to severe symptoms affecting the ability to perform everyday tasks. However, advancements in technology and surgical medicine have allowed for patients to recover and return to most of their normal activities.
A complete overview of the spinal column is discussed in greater detail below along with risk factors and treatment options available for a herniated disc.
Structure of the Spinal Column
What is a Herniated Disc?
Spinal discs can dehydrate and stiffen, causing them to become less able to handle compression. Over time, this can weaken the outer ring and cause the nucleus pulposus to herniate through the protective layer of the annulus fibrosus. This is known as a ruptured or herniated disc and most common in the cervical and lumbar regions of the spine. When this occurs, the nucleus pulposus puts pressure on the nerve root, compressing or “pinching” it. A pinched nerve can cause numbness, tingling, weakness as well as severe pain which can radiate through parts of the body where the nerve root branches out. For the cervical region, pain, numbness, or tingling usually radiates down the arms and/or into the hands and fingers. In the lumbar region, the pain is usually in the lower back and can radiate down the leg and/or into the calf and feet.
Symptoms of a Herniated Disc
Symptoms can include:
- Arm or leg pain, usually described as a sharp, shooting pain or burning sensation that may occur when moving into certain positions or when sneezing or coughing. In the neck, you will typically feel the most pain in your shoulder or arm. In the lower back, you will typically feel the most pain in your buttocks, thigh and/or calf.
- Numbness or tingling can be experienced at the herniation site, as well as the part of the body affected by the compressed nerve root.
- Weakness is normally experienced in the muscles that are affected by the compressed nerve root.
- Bladder or bowel control can be impaired by a pinched spinal cord or pinched nerves. Loss of bladder or bowel control is an indication for early surgery.
Diagnosis & Treatment Options
A herniated disc can be diagnosed by a physician after discussing a patient’s symptoms, reviewing medical history, and performing a physical examination. The examination will usually involve a neurological exam to help determine if there is muscle weakness or loss of sensation.
The most common and preferred imaging for this condition is a magnetic resonance imaging (MRI) scan. This type of diagnostic test can produce 3-D images of the body structure surrounding the affected area. This includes soft tissue—such as the intervertebral discs—the spinal cord, nerve roots, and other key structures. It can detect degeneration, tumors, and other anomalies which can cause similar symptoms. If an MRI is not available, a computerized tomography (CT) scan or a myelogram may be ordered instead.
Initial treatments of a herniated disc should be conservative. Approximately 50% of patients with Lumbar disc herniations improve with time. Many cases of a herniation can be treated by non-surgical means, such as:
- Rest– One to two days of bed rest may help relieve back pain symptoms. Activities that cause stress to the affected area should also be limited and controlled.
- Medications– The use of nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen can help to relieve pain.
- Physical therapy– Specific exercise regimens can help strengthen the muscles that help support the lower back and spine.
- Epidural steroid injection– An injection of a steroid medicine into the space around the affected nerve root has shown to successfully relieve pain in many patients who have not seen improvement following six weeks or more of other non-surgical care.
Most cases of a herniated disc can be resolved without the need for surgery. However, a patient should speak with their physician about surgery if:
- The patient has progressive loss of nerve function.
- Symptoms have not improved with non-surgical treatment.
- The patient’s level of pain is severe.
- The patient is having trouble standing or walking.
- The patient is unable to control their bowels or bladder.
- The patient has trouble with coordination of fine motor skills
Surgical treatments for a herniated disc include:
- Microdiscectomy– This is the most common surgical procedure to treat a single herniated disc. This is a minimally invasive procedure involving the removal of the damaged or protruding portion of the disc without removing the entire disc.
- Laminectomy/laminotomy– This procedure is used to remove some or all of the portion of the vertebra called the lamina. This allows access to the spinal canal and relieves pressure on the nerve root.
- Spinal Fusion– This procedure is not usually a first line in the surgical treatment of isolated disc herniations in the lumbar spine but in the neck it is commonly used after a discectomy has been performed. It involves fusing the two vertebrae on either side to help stabilize the spine and reduce movement of the bones preventing more pain from occurring.
- Artificial Disc Replacement– This procedure involves removing the damaged disc and replacing it with an artificial disc made of plastic or metal. This type of surgery has gained popularity among surgeons aiming to preserve normal motion and has emerged as an alternative to spinal fusion.
If you are experiencing the above symptoms, be sure to schedule an appointment to talk to your doctor. Our team of experienced and certified orthopaedic surgeons are here to help ease your pain and get you on the road to recovery.