Review some of the most commonly asked questions about a herniated disc:
- What is a herniated disc?
- What causes a herniated disc?
- What are the symptoms of a herniated disc?
- How is a herniated disc diagnosed?
- What are the non-surgical treatment options available for a herniated disc?
- What are the surgical treatment options available for a herniated disc?
- What is the recovery time after herniated disc surgery?
What is a herniated disc?
A herniated disc, also known as a spinal disc herniation or ruptured/slipped disc, is a condition in which the soft center of a disc pushes (herniates) through the exterior, tougher, casing of the disc. This can put pressure on the nerves in the spinal cord and cause pain, numbness, and weakness in the affected area. Due to this displacement, the herniated disc may press on the nerves in the spine, leading to nerve pain and back or neck pain that may be severe.
The disc is the cushion between the cervical, thoracic, and lumbar vertebrae. The disc is cartilage on the outside and a gel-like center or nucleus on the inside. The discs throughout the spine have three main functions:
- Acting as shock absorbers in the spine.
- Acting as supportive structures to hold the vertebrae together.
- Are cartilaginous joints that allow the spine to have slight mobility.
Although the lower back is more common, herniated discs can occur in any part of the spine. Typically, the area in which the pain is felt depends on which area of the spine is affected.
A neurologist will be able to diagnose and treat a herniated disc. Depending on the severity, a neurosurgeon may be involved.
What causes a herniated disc?
Excessive injury or strain may lead to a herniated disc. Spinal discs degenerate naturally as individuals age, and the ligaments surrounding the discs begin to weaken. As spinal degeneration progresses, even a minor twisting movement or strain may cause a disc to rupture.
Research has shown that some individuals may have a predisposition for herniated discs depending on family history. Certain individuals may be more susceptible to spinal disc degeneration and, as a result, may experience herniated discs in multiple areas along the spine.
Disc herniations most commonly occur in the lumbar (lower back) region of the spine, but they can also happen in the cervical (neck) and thoracic (mid-back) regions. Risk factors for developing a disc herniation include aging, obesity, smoking, and repetitive heavy lifting.
What are the symptoms of a herniated disc?
Symptoms for a herniated disc vary greatly. Symptoms will depend on the position of the disc and the size of the herniation. If the herniated disc does not press directly on a nerve, the patient may experience localized back pain and muscle spasms. If the herniated disc is pressing on a nerve, the patient may experience weakness, numbness, or severe pain in the areas of the body to which the nerve travels.
Symptoms of a lumbar disc herniation may include:
- Lower back pain
- Sciatica (pain that radiates down the leg)
- Numbness or weakness in the foot or leg
Symptoms of a cervical disc herniation may include:
- Neck pain
- Headaches
- Numbness or weakness in the arm or hand
- Lumbar (lower back) disc herniations can cause buttock and leg pain, while cervical (neck) disc herniations can lead to arm pain. Pain may progress to sensory loss or weakness if severe.
Sciatica, pain radiating along the sciatic nerve running down one or both legs from the lower back, typically results from a herniated disc in the lower back. Pressure on the nerves leads to pain, tingling, numbness, and burning that radiates from the buttock to the leg. Oftentimes, one side of the body is affected by sciatica. Patients who experience this pain describe it as an electric shock and deep ache in the buttock and leg. The pain may worsen when standing, sitting, or walking.
Cervical radiculopathy is the symptom of a compressed nerve in the neck. This results in a sharp or dull pain in the neck or shoulder blades that radiates down the arm to the fingers. The pain may intensify with specific movements or positions of the neck.
What causes a herniated disc to flare up?
Flare-ups can be caused by activities that put strain on the lower back, including:
- Improper movement: Sudden twisting motions, lifting heavy objects, and overexertion
- Repetitive strain: Repeated stress from activities, such as bending, prolonged periods of sitting, or heavy lifting
- Physical activity: Intense exercise can worsen symptoms
- Postural issues: Poor posture can add more stress to the spine and discs
How is a herniated disc diagnosed?
Depending on symptoms, individuals will visit doctors for a diagnosis. Diagnosis of a disc herniation typically involves a physical examination and imaging tests, such as an MRI or CT scan. Spinal disc herniation is a common condition that can cause significant pain and discomfort, but it can be effectively treated with a variety of options. It is essential to seek medical attention if you are experiencing symptoms of disc herniation and work with your healthcare provider to determine the best course of treatment for you.
In some cases, the pain from a herniated disc may be so severe that a person seeks care in an Emergency Room. Oftentimes, a herniated disc is diagnosed with a physical exam and medical history.
If your doctor needs to see which nerves are affected, he or she may order one or more of the following tests:
- X-rays: Do not detect herniated discs, but assist the doctor in ruling out other causes of back pain, such as spinal alignment issues, a broken bone, tumor, or infection
- CT scan: Combines a series of X-rays from different directions to create cross-sectional images of the spinal column. CT scans are better for seeing bone rather than soft tissue like a disc, but in some cases, they can detect disc herniations if they are relatively large.
- MRI: The best available imaging study to detect a disc herniation. The MRI creates images of the body’s soft tissues and confirms the location of the herniated disc, the size of the disc herniation, and which nerves are affected.
- Myelogram: Injected dye into spinal fluid prior to CT scan to show the pressure on the spinal nerves or chord due to herniated discs. This older test is not often used unless there are special circumstances (i.e., an inability to have an MRI).
How do you treat a herniated disc in the lower back?
Treatments for a herniated disc in the lower back (lumbar spine) typically begin with non-invasive approaches:
- Rest: It is important to avoid activities that worsen the pain. Gentle movements and walking can help prevent stiffness.
- Physical Therapy: Exercises can help strengthen muscles around the spine, increase flexibility, and improve posture to alleviate pressure on the herniated disc and reduce pain.
- Medications: Over-the-counter pain medications help to manage mild pain. Meanwhile, in some cases, stronger prescriptions may be used for short periods.
- Hot or Cold Therapy: Ice or heat packs can help reduce muscle spasms and inflammation.
- Epidural Steroid Injections: If pain is severe and does not improve with other treatment options, a doctor may recommend an epidural steroid injection to provide temporary pain relief.
- Surgery: If conservative treatment fails, surgical treatment is considered and involves procedures like a discectomy or spinal fusion; however, most people improve without the need for surgery.
Can a herniated disc go back into place?
While a herniated disc cannot usually “go back in place,” symptoms can improve as the disc fragment shrinks over time and the pressure on the nerves lessens. This leads to an overall reduction in discomfort and pain.
What are the surgical treatment options available for a herniated disc?
If conservative treatment options, such as medications and physical therapy, do not reduce the pain, your doctor may recommend surgery. The most common surgical procedure for a disc herniation is a microdiscectomy. If there is significant muscle weakness, sensory loss, or other worrisome neurological signs from the disc herniation, your doctor may recommend immediate surgical treatment. Your age, overall health, and other issues will be considered when considering surgical options.
The good news is that a large percentage of patients who have undergone surgery for a disc herniation report significant pain relief after surgery. It is important to note, though, that there is no guarantee that surgery will ease pain.
You may be considered as a candidate for spinal surgery if you experience the following:
- Difficulty walking or standing
- Ineffective medication and physical therapy
- Loss of bladder or normal bowel functions
- Pain that impairs quality of life
- Leg weakness and/or numbness
- Surgical options for disc herniation include a discectomy, which involves removing the herniated portion of the disc, or a laminectomy, which involves removing a portion of the vertebra to alleviate pressure on the nerves.
- Surgery is typically recommended for those who have not seen improvement with conservative treatment options or those with severe nerve compression.
Lumbar Spine Discectomy
Lumbar laminectomy and microdiscectomy is a procedure that relieves sciatica and leg pain caused by a herniated disc. The procedure is performed through a small incision over the area of the herniated disc. The herniated part of the disc is removed using a microscope and small instruments. In more complex cases, a spinal fusion may be performed in conjunction with a laminectomy. Your doctor will discuss this option and how to prepare for a lumbar discectomy with you ahead of time.
Cervical Spine Discectomy
A cervical disc herniation may be performed from an incision on the neck’s front (anterior) or back (posterior). The decision to operate the front of the neck or from the back of the neck depends on the exact location of the herniated disc. Patients who are candidates for posterior surgery typically do not need a spinal fusion. For anterior surgery, the spine needs to be stabilized after the disc is removed. Spinal stabilization is accomplished using small screws, interbody devices, and a cervical plate.
What is the recovery time for herniated disc surgery?
The recovery after a cervical or lumbar discectomy is fairly quick. Most patients will go home later in the day or the following day. You can expect some postoperative discomfort for 1-2 weeks. The recovery time is determined by the complexity of the surgery and the patient’s overall medical condition. Your doctor will provide specific instructions after your surgery and will often prescribe pain medications to help with any postoperative pain. Your doctor will help you decide when to resume normal activities, such as exercising, driving, and returning to work. Most patients can expect a return to full activity in 4-6 weeks.
Some patients benefit from physical therapy or supervised rehabilitation after the procedure. As you gradually return to regular activity, some discomfort is expected, but any pain is a warning signal that you may need to slow down.
At New Jersey Brain and Spine, we evaluate and treat patients with spinal disc herniations very frequently, and most of our patients recover without requiring surgery.
How long does it take to heal a herniated disc naturally?
Healing times vary significantly for a herniated disc based on several factors, including the severity of the herniation, the treatment approach, and overall health. In general, many people see improvement within 6 to 8 weeks with conservative treatments, such as physical therapy, rest, and pain management.
However, full recovery may take several months, with specific symptoms persisting for extended periods. When healing a herniated disc naturally, the goal is to reduce inflammation and alleviate pressure on nearby nerves.
What is the newest treatment for a herniated disc?
Recent medical advancements in technology have led to innovative treatment options, including minimally invasive procedures, for herniated discs:
- Minimally Invasive Discectomy: Involves making smaller incisions and using advanced instruments to remove the herniated portion of the disc, leading to reduced complications and quicker recovery times.
- Stem Cell Therapy: Stem cell injections are a newer approach to regenerate damaged tissues in the spine and promote healing in degenerated discs. At this time, the role of stem cell therapy for disc disease is not clear.