Herniated Disc

A herniated disc is a condition in which a part of vertebral disc, normally placed between the two vertebrae, protrudes and presses the nearby structures. 

Spinal disc is a jelly-like structure consisted of soft inner core(nucleus pulposus)  and tighter exterior ring( annulus fibrosus). 

This condition occurs when a soft inner core leaks through a rupture in exterior ring. The most frequently affected structures are the nerves, which results in pain, numbness or weakness in the limbs.  

In some cases, this condition develops without any symptoms. Most of the patients do not require surgery.

Signs and symptoms of herniated disk include:

• Limb pain: If the herniated disc occurs in the lower back, you’ll typically feel the pain in your gluteal region and legs (thigh, calf, foot etc...). If your herniated disc is in your cervical spine, the pain will typically be present in the shoulder and arm. This pain has a tendency to be intensified when you make fast and sudden moves.

• Weakness: Muscles innervated by the affected nerves tend to weaken. This can cause you to stumble or to be unable to hold things for long.

• Numbness and tingling: Disc herniation can press your nerves and impair their sensory function, which can be presented with numbness and tingling in the affected innervation region.

There is a possibility that you have this condition without even knowing it. This symptom free protrusion can regularly be found on spinal images that were taken for other reasons. 

Herniated disc  is mostly found in your lower back ( lumbar spine) and cervical spine. 

Herniated disk is most commonly caused by disc degeneration, which is age-related. 

The reason for degeneration is gradual loss of water content in the disc, which makes it less elastic and more prone to damage. 

Less frequent causes include traumas and inadequate use of muscle groups while lifting heavy loads. 

In most cases of herniated disk, a physical exam and a medical history are all that's needed to make a diagnosis.

If you experience symptoms of the condition, you should see your doctor. He may refer you to the physical medicine and rehabilitation specialist, orthopedic surgery specialist, neurologist or neurosurgeon. 

Do not forget to mention all the symptoms you are experiencing, history and chronology of their development, traumas, activities, other medications that you are taking etc. 

Your doctor is expected to perform basic physical examination which includes checking your back for pain and tenderness and moving your limbs in various positions. 

Also he may perform neurological examination such as: 

• checking your reflexes
• ability to walk
• muscle strength
• ability to determine light touches, and vibrations.

Other procedures include X-ray of the suspected region, CT, MRI, myelogram, electroneurography etc. 

All of these are used to determine exact location and extent of the damage.

Herniated disc can be treated either with conservative treatment or surgical treatment. Conservative treatment is consisted of exercise regime and medications, which is know to relieve symptoms in 90% of the affected. 

You should avoid painful positions as much as possible. Physical therapy should be conducted as shown by the therapist.

Medications 

If your experience mild to moderate pain you may be told to take pain medication such as nalproxen or ibuprofen. 

In case your pain persists you may be prescribed narcotic medicines such as codeine or oxycodone-acetaminophen combination, short term. These medications are know to cause various unpleasant side effects. 

Other medications include: 

• Nerve damage pain medications such as duloxetine, gabapentin, tramadol, amitriptyline, pregabalin.
• Muscle relaxers – for muscle spasms
• Cortisone injections – to reduce inflammation around the nerve.

A limited number of patients will require surgical treatment. This may happen if conservative treatment fails to work within the 6 week period, or symptoms such as weakness, inability to walk, inability to control urination etc.,  continue to persist. 

Surgeon can either remove the protruding part of the disc, use implants for stability, or replace the whole disc.  

In order to prevent disc herniation you should:

• Exercise more – strengthen the muscles around your spine.
• Lift heavy load properly - use your legs instead of your back.
• Maintain proper posture.
• Maintain normal weight -being overweight puts more pressure on the spine and discs.

Lifestyle modifications are necessary in order to cope with herniated disk.

Pain is known to affect your psychological and emotional state. It increases the level of stress which can consequently aggravate your pain.  

You should focus on stress management using various widely-known techniques.  You should also consider seeking advice from a mental health counselor.

There are many factors that can increase your risk of a herniated disc and contribute to the worsening of the condition.These include: 

• Being overweight – this puts excess pressure on the discs.
• Your occupation – you are on higher risk if your occupation includes pulling, pushing, lifting, bending, twisting etc.
• Genetics – it is believed that many people have an inherited preposition to develop a herniated disc. 

In some cases, disc protrusion can press the lower part of the spinal cord called cauda equina, and cause cauda equina syndrome. 

This syndrome is characterized by worsening pain, bladder and bowel dysfunction, extreme numbness and weakness etc. It can lead to permanent damage, weakness or paralysis. 

If you experience any of the above-mentioned symptoms, seek medical attention immediately!