Herniated Discs

About Herniated Discs

Herniated discs occur when the jelly-like material in the center of the disc, known as the nucleus pulposus, is forced beyond the outer disc wall and into the area where your spinal nerves reside. This can place pressure against a nerve, leading to irritation and inflammation that can cause pain, sensory changes, or weakness in the arms or legs. This condition is commonly referred to as a pinched nerve, but medically is called a radiculopathy.

The diagnosis of a herniated disc is usually based on the clinical history and exam as well as findings from an MRI. Initial treatment usually consists of anti-inflammatory medications and physical therapy. Most disc herniations resolve without surgery. If conservative treatment fails, surgery is usually very successful. Surgery can be performed through minimally invasive techniques that relieve the pressure on the spinal nerve, reduce inflammation, and allow symptoms to subside.

Herniated discs can occur in any part of the spine and the location of the disc herniation determines the type of symptoms that will develop. The level of pain experienced does not directly correspond with the severity of damage to the disc. Large herniated discs can cause minimal or no  pain while a small herniation can lead to severe pain. Some herniated discs cause no symptoms and go unnoticed.

Degenerative disc disease can often lead to a herniated disc. As aging occurs the discs in the spine become less flexible and the outer part becomes more brittle and likely to tear. Herniated discs can also occur in younger people due to trauma. It is also possible that a bulging disc can develop into a herniated disc over time.

Common Symptoms of a Herniated Disc

Symptoms of a herniated disc vary depending on what section of the spine is affected.  Usually cervical herniated discs are less common than a lumbar herniated disc due to the smaller size of the cervical disc and less force exerted across the neck. In the neck, the spinal cord or spinal nerves may be affected, leading to different symptoms.  In the lower back only the spinal nerves will be affected.

Symptoms for a herniated disc in the cervical spine include:

  • Pain/weakness/numbness in neck, shoulders, or arms
  • Loss of hand dexterity
  • Numbness/stiffness/ weakness in legs
  • Possible difficulty with bowel & bladder control

Symptoms for a herniated disc in the thoracic spine include:

  • Pain in the mid back
  • Pain traveling through the ribcage, back/front of chest, and upper abdomen
  • Numbness/stiffness/weakness in legs
  • Possible difficulty with bowel & bladder control

Symptoms for a herniated disc in the lumbar spine include:

  • Back spasms/pain
  • Pain starting from the back or buttock & travels down the leg
  • Numbness in leg/foot
  • Weakness in legs/ difficulty walking
  • Changes in bowel/bladder functions

Diagnosis of a Herniated Disc

Diagnosis of a herniated disc is sometimes difficult, as symptoms can be misunderstood by both patients and doctors. Symptoms for herniated discs can resemble symptoms of other medical conditions. This confusion also stems from the many different terms that are used to describe a disc herniation. Some of these terms include pinched nerve, bulging disc, ruptured disc, or slipped disc. These terms are used differently by different doctors, but generally indicate the same process.

Different tests are ordered by doctors if symptoms associated with a herniated disc are present. These tests include an MRI scan, a CT scan, myelography, or EMG/Nerve Conduction Studies. MRI is the imaging test of choice, clearly defining the relationship of the herniated disc with the involved nerves. EMG/NCV tests the electrical activity of a nerve to determine which nerve is not functioning properly.

Treatment Options for a Herniated Disc

Treatment for each case of a herniated disc is different depending on the patient. The common goal of all treatment is to eliminate pain and symptoms that are caused by the herniated disc. Most cases of a herniated disc are first treated with nonsurgical options. These options are usually applied for 4-6 weeks to try and reduce pain. Different treatments need to be tried and combined during this stage to maximize benefit. If nonsurgical approaches are not successful by 6-12 weeks or if the patient experiences increasing loss of neurological function, surgery is appropriate.

Non surgical treatments include:

  • Activity modification
  • Medications
  • Physical therapy
  • Injections

Surgical treatments include:

  • Microdiscectomy – minimally invasive procedure to remove the portion of the disc causing pressure on the nerve.
  • Anterior cervical discectomy and fusion – removal of the herniated disc through the front of the neck with placement of bone graft and metallic plate/screws to fuse the spine.
  • Anterior cervical discectomy and arthroplasty – removal of the herniated disc through the front of the neck with placement of a synthetic device that replicates the normal disc motion.