What are Disc Herniations?
Round cushions protect the bones that form the spine along the back with a tough, outer layer called annulus. These discs are located between each of the vertebra in the spinal column, acting as “shock absorbers” for the spinal bones.
Unfortunately, those discs can become herniated, which may indicate the early stages of degeneration. The spinal canal has limited space, which is inadequate for the spinal nerve and the displaced herniated disc fragment. As a result, a painful compression and “pinching” of the nerve can occur. Herniated discs are more common in the lower back (lumbar spine), but also occur in the neck (cervical spine).
Bulging disc - With age, the intervertebral disc may lose fluid and become dried out. As this happens, the spongy disc becomes compressed, which may lead to the breakdown of the tough outer ring. This allows the nucleus, or the inside of the ring, to bulge out, being aptly named bulging disc.
Ruptured or herniated disc - As the disc continues to break down, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured — or herniated — disc. The fragments of disc material can then press on the nerve roots located just behind the disc space. This can cause pain, weakness, numbness, or changes in sensation.
What Causes Disc Herniations?
Age is the most common risk, because as degeneration from age progresses, a relatively minor strain or twisting movement can cause a disc to rupture. There are other risk factors as well:
- Weak back and abdominal muscles caused by physical inactivity, may not support the spine properly.
- Back injuries also increase when people who are normally not physically active participate in overly strenuous activities.
- Jobs that require heavy lifting and twisting of the spine can also cause back injuries.
- Certain individuals may be more vulnerable to disc problems and, as a result, may suffer herniated discs in several places along the spine.
- Hereditary factors.
What are the symptoms of lumbar disc disease?
Symptoms vary greatly, depending on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, the patient may experience a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.
The symptoms of lumbar disc disease vary depending on where the disc has herniated, and what nerve root it is pushing on. These are the most common symptoms of lumbar disc disease:
- Intermittent or continuous back pain. This may be made worse by movement, coughing, sneezing, or standing for long periods of time.
- Spasm of the back muscles
- Sciatica. This is pain that starts near the back or buttock and travels down the leg to the calf or into the foot.
- Muscle weakness in the legs
- Numbness in the leg or foot
- Decreased reflexes at the knee or ankle
- Changes in bladder or bowel function
- The symptoms of lumbar disc disease may look like other health conditions. Always see your healthcare provider for a diagnosis.
How is Lumbar Disc Disease Diagnosed?
In addition to a complete medical history and physical exam, you may have one or more of the following tests:
- CT Scan
- Electromyography (EMG)
How is Lumbar Disc Disease Treated?
Typically, conservative therapy is the first line of treatment to manage lumbar disc disease. This may include a mix of the following:
- Bed rest
- Educating yourself in your limitations
- Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
- Maintain a healthy weight
- Back support
- Pain medicine
Treatment for Herniated Disc
The initial treatment for a herniated disc is usually conservative and nonsurgical.
- Low, painless activity level for a few days to several weeks so that spinal nerve inflammation may decrease.
- Bedrest is not recommended.
- A nonsteroidal anti-inflammatory medication, if the pain is only mild to moderate.
A doctor may recommend surgery if conservative treatment options, such as physical therapy and medications, do not reduce or end the pain. The benefits of surgery should be weighed carefully against its risks.
A patient may be considered a candidate for spinal surgery if:
- Radicular pain limits normal activity or impairs quality of life
- Progressive neurological deficits develop, such as leg weakness and/or numbness
- Loss of normal bowel and bladder functions
- Difficulty standing or walking
- Medication and physical therapy are ineffective
- The patient is in reasonably good health