Human spine or backbone comprises 33 bones, known as vertebrae. There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. There is the sacrum (5 vertebrae fused together) beneath the fifth lumbar vertebra, followed by the coccyx or tail bone (3 vertebrae fused together). These vertebrae are cushioned by small, soft pads of cartilage. Spinal discs comprise a gel-like inner layer, called nucleus pulposus, and a tough outer layer, called annulus fibrosus. These discs act as shock-absorbers, and protect the spine from any kind of injury or stress. Spinal discs also help in the bending movements of the spine.
If the spinal disc degenerates due to aging or any injury, the soft inner layer may rupture and herniate through the annulus fibrosus. This can cause irritation of the spinal nerve, leading to pain, weakness and numbness in the lower back, arm, and leg. This condition is known as a herniated disc. It is also referred to as compressed disc, bulging disc, prolapsed disc, slipped disc, ruptured disc, or herniated intervertebral disc. It commonly occurs in between the fourth and fifth lumbar vertebrae in the lower back (lumbar spine); however, it can also occur in the cervical spine.
Herniated disc when associated with wear and tear due to aging is known as degenerative disc disease. As the water content and elasticity of the nucleus of the disc reduce with advancing age, people between the age of 30 and 50 are at higher risk of developing a herniated disc. Lifting heavy objects can also lead to spinal disc herniation.
Sometimes, traumatic events such as a fall or any injury to the spine can also cause this condition. Smoking reduces the oxygen levels in the body, causing a deficiency of vital nutrients in the tissues, and thus increasing the risk of a herniated disc. Some other risk factors include excess body weight, being very tall (men taller than 5 feet 11 inches and women taller than 5 feet 7 inches), and engaging in occupations that exert an excess stress on the spine.
Severity of the symptoms may vary depending upon the position and the size of the herniation. If the herniated disc is pressing on the nerve roots, then it can cause pain and numbness in the back and legs. However, if it is in the lower back, then it causes back pain, known as sciatica, that spreads to the buttocks and legs. Lower back pain and leg pain may worsen after sitting, sneezing, or coughing. If herniated disc occurs at upper back, then it can lead to neck pain that may spread to the shoulders and upper arms.
Some other symptoms are numbness, tingling, weakness, and muscle spasms. In some rare cases, this condition can lead to the development of the cauda equina syndrome, which is caused due to the compression of the spinal nerve roots. Emergency surgery is required to relieve the pressure, and cure the syndrome; otherwise it can cause permanent weakness or even lead to paralysis. If left untreated, herniated disc can lead to complications such as increasing pain and numbness in one or both legs, bowel or bladder dysfunction, and progressive loss of sensation.
If you experience back pain or leg pain that interferes with normal activities for more than a week, then you should consult an orthopedist. Certain tests are suggested by the doctor for the diagnosis of herniated disc such as straight-leg-raising test, cross straight-leg-raising test, and screening neurological examination. Certain imaging tests like X-ray, CT scan, MRI scan, and myelogram are performed to confirm the location of the herniated disc, and to detect which nerve is affected.
Treatment for herniated disc is decided depending upon the severity of the symptoms. There are surgical as well as non-surgical options. Non-surgical methods include pain relievers, anti-inflammatory medications, physical therapy, hydrotherapy, electrical stimulation, cold therapy, heat therapy, bracing, traction, and stretching. You can also benefit from certain exercises like dynamic lumbar stabilizing exercises and aerobic exercises with pain-free activities. In some severe cases, surgical options such as minimally invasive decompression procedures are recommended.
Nonsurgical Treatment: Many a time, herniated disc improves with nonsurgical treatment options, which aim at reducing irritation of the nerve, relieving pain, and improving physical activities. Primary treatment is administered for back pain relief. You need to limit or modify the activities like prolonged sitting, lifting heavy objects, or bending, which can aggravate the symptoms. Physical therapy and exercises can help increase strength and flexibility. Pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin can help to reduce pain and relieve inflammation of the nerve roots.
Neuropathic pain medications like pregabalin, gabapentin and duloxetine are effective for painful nerve conditions. Lower doses of tricyclic antidepressants like nortriptyline can also help to relieve pain. If you have persistent back spasms, then your doctor may prescribe muscle relaxants like methocarbamol, cyclobenzaprine or carisoprodol. If pain is not improved with these medications, then corticosteroids are administered orally or through epidural injection. Some other treatment options that include cold or heat therapy, bracing, transcutaneous electrical nerve stimulation (TENS), hydrotherapy, and traction are also helpful in relieving pain.
Once the pain is relieved, the treatment is focused on strengthening and stabilizing the spine, and to restore spinal function. Rehabilitation involves physiotherapy and various exercises such as stretching, aerobics, and dynamic lumbar stabilization exercise. These back strengthening exercises help control pain, correct the posture, strengthen the muscles, and improve flexibility.
Surgical Treatment Options: If you don't experience any improvement with nonsurgical treatment options after a period of time, then surgical options are recommended. Surgical treatment is aimed at relieving pain and preventing irritation of the spinal nerve due to the herniated disc. Minimally invasive procedures include chemonucleolysis and endoscopic discectomy. Open decompression involves discectomy, microdiscectomy, and spinal fusion.
Herniated disc can also be treated with some alternative treatment options such as acupuncture, massage, spinal manipulation, and yoga. You can prevent it by doing regular exercise, maintaining good posture and healthy weight, and quitting smoking.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.