Herniated Disc: Symptoms, Treatment, Outlook
- Herniated disc goes by several names: bulging disc, slipped disc, or ruptured disc.
- In some cases a herniated disc may only cause minor pain, however if pressed against the sciatic nerve, it can cause a painful condition called sciatica.
- Improper lifting is one of the key causes of herniated disc.
- Depending on the severity, herniated disc can be treated nonsurgically. In some cases, the condition will heal itself in a process called resorption.
- Diet, exercise, and changes in posture and ergonomics are ways to help prevent the condition.
A herniated disc is a problem with one of the spinal discs that provides cushioning for the bones (vertebrae) of the spine. This condition is also known as a bulged, slipped or ruptured disc.
Spinal discs are round and flat. They have a tough, outer layer called the annulus and a soft, jellylike interior known as the nucleus. If the outer layer tears or ruptures, the softer “jelly” can push out.
Herniated discs are more common in the lower back, or lumbar spine. Herniated discs can also occur in the neck, or cervical spine.
If a herniated disc presses on the spinal nerves, it can cause pain, numbness or weakness in an arm or leg. Some people, though, experience no symptoms. Most herniated discs do not require surgery.
Symptoms depend on which disc is herniated and how severe it is. If the herniated disc does not press on a nerve, a person may have no pain at all or only a minor backache.
If the herniated disc presses on a nerve, a person may experience pain, weakness or numbness in the part of the body where the nerve travels. People may have one or more episodes of back or neck pain before the disc herniates.
Herniated discs in the lower back and neck have distinct symptoms:
- Lower back. If the herniated disc presses on the sciatic nerve, it can cause sciatica. This shows up as pain, tingling, burning or numbness in one buttock and leg, and occasionally in the foot on that side of the body. The pain can sometimes feel like an electric shock. It may worsen while sitting, standing or walking. Some people also have pain in the lower back.
- Neck. A herniated disc in the neck can produce a dull or sharp pain in the neck, between the shoulder blades or in the arm, hand or fingers. There may also be tingling or numbness in the arm or shoulder. The pain sometimes increases while moving or holding the neck in a certain way.
The risk of a herniated disk increases as you grow older. This is because as you age, the spinal discs become less flexible and are more likely to rupture or tear.
Sometimes, disc herniation happens during a single injury or excessive strain on the neck or back. Most people, though, cannot identify the exact cause of their herniated disk. Even a minor twisting or strain can cause a spinal disc to rupture.
Several risk factors increase the chance of developing a herniated disc, including:
- Older age, which causes the spinal discs to degenerate and the ligaments that hold them in place to weaken
- Family history of herniated discs
- Physically demanding jobs that require moving heavy or awkward objects, as well as jobs with repetitive movements like bending and twisting of the spine
- Excess weight, which puts extra stress on the discs in the lower back
- Genetic or other factors that make discs more likely to tear or rupture
Besides asking about a person’s symptoms and medical history, and conducting a physical exam, a doctor may use the following tests to diagnose a herniated disc:
- X-ray. This uses radiation to produce an image of the bony parts of the spine, such as the vertebrae and the joints that join them. Doctors look for Schmorl’s Nodes, which are vertical disc herniations through the cartilaginous vertebral body endplate.
- Computed tomography scan (CT or CAT scan). A series of X-rays read by a computer that can show the spinal canal formed by the vertebrae, the spinal cord and nerves, and the joints and structures around the vertebrae.
- Magnetic resonance imaging (MRI). Powerful magnets are used to produce 3D images of the body, including the spinal cord, spinal nerve roots and nearby tissues. This detailed medical imaging can identify discs that have degenerated as well as tumors in the spine.
- Myleogram. A contrast material is injected into the space surrounding the spinal cord to make soft tissues of the spine show up on an X-ray. It can show whether the spinal cord or spinal nerves are compressed by a herniated disc, bone spurs or tumors.
- Electromyogram and Nerve Conduction Studies (EMG/NCS). These measure the electrical impulses that pass along the nerves to the limbs, including the ones that run to the muscles (motor) and those that detect feeling (sensory). This can show whether another injury or condition is affecting the nerves.
Most people do not require treatment for a herniated disc. However, some people will experience severe low back pain or other symptoms that affect their daily activities.
A doctor will usually first prescribe nonsurgical therapies to reduce inflammation and pain related to a herniated disc, including:
- Rest. Taking it easy for a few days to several weeks can reduce the symptoms and avoid making them worse.
- Nonsteroidal anti-inflammatory medications. These over-the-counter or prescription drugs can reduce the inflammation related to a herniated disc that causes pain. These include aspirin and ibuprofen.
- Steroid injections. Steroids are injected into the area around the herniated disc using a spinal needle to reduce inflammation.
- Physical therapy. A therapist will use therapies designed specifically to relieve symptoms of disc herniation. This includes ice and electrical muscle stimulation, gentle massage, traction and stretching exercises, and sometimes muscle relaxants or pain medication. Heat will make the disc area swell and should be avoided.
- Yoga and Pilates. When done properly, these can help strengthen the muscles of the core which may relieve the symptoms of a herniated disc. Yoga and meditation can also relieve pain.
- Chiropractic Care. Spinal disc decompression therapy, a low-force decompression technique, can take pressure off the herniated disc.
If nonsurgical therapies do not reduce or end the pain, or if symptoms of a herniated disc worsen, a doctor may recommend spinal surgery. Several types are available, including:
- Lumbar laminotomy and discectomy. This procedure targets sciatica and leg pain caused by a herniated disc. An incision is made in the back at the level of the herniated disc. A piece of the back of the bony vertebrae (lamina) may be removed to relieve pressure on the spinal cord and nerves. The herniated disc is then removed. Spinal fusion surgery may also be done to stabilize the spine. This involves using metal devices and bone grafts to attach the adjacent vertebrae.
- Lumbar artificial disc surgery. In this surgery, the herniated disc is removed and replaced with an artificial disc device. It can only be done between certain vertebrae in the lower back. This procedure also will not work for every patient.
- Cervical laminotomy and discectomy. Similar to lumbar laminotomy, this procedure can be done through the front of the neck (anterior) or the back of the neck (posterior). Surgeons remove the herniated disc and stabilize the spine with metal plates and screws, and usually spinal fusion surgery.
It is not possible to stop the natural degeneration of the spinal discs that occur with aging, but there are ways to reduce the risk of a herniated disc, including:
- Do exercises to strengthen the core, including the muscles of the abdomen, lower back, sides of the lower torso, and the pelvic floor.
- Choose aerobic exercises that are low-stress for your back, such as swimming, walking, and stationary bicycling.
- When lifting heavy objects, squat down and keep your torso upright. Lift with your legs, not your back. Get help when lifting an object that is awkward or too heavy for you to lift alone.
- Maintain good posture while standing and sitting, especially when doing it for long periods.
- Stop using tobacco products, which is a risk factor for hardening of the arteries (atherosclerosis) and degenerative disc disease.
- Maintain a healthy weight. Excess weight can put extra strain on the lower back.
Most people with a herniated disc will not require surgery. The symptoms often lessen or go away completely over time with nonsurgical therapies. Many people who require surgery for a herniated disc find that their pain level is decreased afterwards. However, as with all surgeries there is no guarantee of success.
A herniated disc is often the result of age-related wear and tear on the spinal discs in between the vertebrae. You can’t stop those changes from happening. But it is possible to make simple lifestyle changes to help prevent lower back pain and disc herniation.