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:

  1. Acting as shock absorbers in the spine.
  2. Acting as supportive structures to hold the vertebrae together.
  3. 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:

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 that experience this pain describe it as an electric-like shock and deep ache in the buttock and leg. The pain may worsen when standing, sitting or walking. 

Cervical radiculopathy is the symptoms of a compressed nerve in the neck. This results in a sharp or dull pain in the neck or in the shoulder blades that radiates down the arm to the fingers. The pain may intensity with certain movements or positions of the neck. 

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 important to seek medical attention if you are experiencing symptoms of a 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 can in some cases CT scans can detect disc herniations if they are fairly 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 is an older test not often used unless there are special circumstances (i.e. inability to have an MRI).  

What are the non-surgical treatment options available for a herniated disc?

Most patients with disc herniations do not need surgery. The initial treatment for a herniated disc is usually nonsurgical and conservative. At first, your doctor may advise you to maintain a low activity level for a few days to a few weeks.  Often, a patient with a herniated disc can recover on their own, taking from a few days to a few weeks. A neurologist can help with pain by providing nonsteroidal anti-inflammatory medication (NSAIDs like Advil or Aspirin) or an epidural steroid injection. If these don’t work, the neurologist may recommend surgery.

Treatment options for a disc herniation may include physical therapy, medication, or surgery. Conservative treatment options such as physical therapy, pain medication, and hot and cold therapy can be effective for managing symptoms.

If the pain is mild to moderate, you may take nonsteroidal anti-inflammatory medication (NSAID) such as Motrin or Ibuprofen. Your doctor may prescribe a short course of steroids which is stronger and usually more effective than NSAIDs. Additionally, muscle relaxants may be prescribed to decrease muscle spasms. 

 If the pain is persistent, an epidural steroid injection may be administered. The injection is administered using a spinal needle with X-ray guidance to ensure the medication reaches the exact location of the disc herniations. 

In addition, your doctor may recommend physical therapy once the acute symptoms subside. A physical therapist performs an in-depth evaluation, along with the doctor’s diagnosis, to create a treatment plan specifically for herniated discs. Therapy treatments may include ice and heat therapy, gentle massage, ultrasound electrical muscle stimulation and stretching exercises. Muscle relaxants and pain medication may also be helpful in conjunction with physical therapy. 

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. When considering surgical options, your age, overall health and other issues will be taken into consideration. 

The good news is that a large percentage of patients that 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 a 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 with you ahead of time.

Cervical Spine Discectomy

A cervical disc herniation may be performed from an incision on the front (anterior) or back (posterior) of the neck. The decision to perform the operation from 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 decide when you can 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 normal 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.

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