A herniated disc, also known are a ruptured or slipped disc, is a damaged spinal cushion between two bones in the spine (vertebrae). Normally, the gelatinous discs between the vertebrae hold the bones in place and act as shock absorbers, permitting the spine to bend smoothly. When a disc protrudes beyond its normal parameters and its tough outer layer of cartilage cracks, the disc is considered to be herniated.
The inner material of the disc bulges through the torn cartilage, sometimes pressing on a nerve in the spinal canal. This results in back pain, often sciatic pain that extends into the buttocks and travels down the affected leg. Herniated discs occur most frequently in the lumbar (lower) region of the back and are one of the most common causes of such pain. Cervical (neck) discs may also herniate, resulting in pain in the neck and shoulders.
Causes of a Herniated Disc
During the normal process of aging, the discs in the back lose flexibility and wear down. Additional stress may result in herniation. Such stress may result from obesity, heavy lifting, or sudden traumatic injury. Smoking is also a risk factor for disc herniation.
Symptoms of a Herniated Disc
In addition to pain in emanating from region of the herniation, patients may also experience numbness, tingling, muscle spasms or weakness. The pain that results from a herniated disc is usually worsened by moving and improved by rest. Sudden motions, such as bending or coughing, may elicit sharp, shooting pain.
Diagnosis of a Herniated Disc
In order to make a correct diagnosis of back pain, a medical history must be taken. It is important for the doctor to evaluate whether the pain has been increasing gradually or was precipitated by a traumatic injury. A comprehensive physical exam, including a check of reflexes, sensation or numbness, posture and muscle strength, will help the doctor assess the situation. Usually, the patient is examined sitting, standing and walking in order to pinpoint the problem area of the spine.
In most cases, one or more imaging tests is administered to provide a more precise visualization of the spine, both to determine whether there is a disc injury and, if there is one, to delineate its size and location. These tests may include X-rays, and MRI or CT scans, electromyography to measure nerve impulses, and a myelogram, in which contrast dye illuminates the affected region.
Treatment of a Herniated Disc
Conservative treatments for herniated discs usually begin with bed rest, anti-inflammatory and pain medications as needed. Applications of hot or iced compresses, sometimes in alternation, are frequently recommended. Muscle relaxants may be prescribed to diminish muscle spasms in the back. Sometimes a course of physical therapy to stretch and strengthen back and abdominal muscles can provide relief. Epidural injections of a corticosteroid may also be administered to reduce nerve irritation and facilitate healing. For some patients, chiropractic care or some type of alternative medicine may also provide relief.
When the condition does not respond to these measures, and the patient is still experiencing pain, surgery may be necessary. This is true in approximately 10 percent of all patients with herniated discs. The type of procedure performed will depend upon where the herniated disc is located and on the severity of the damage. There are several surgical options. All of these operations all are performed in the hospital under general anesthesia:
- Spinal fusion
During a laminotomy, the protruding portion of the disc is excised, whereas during a discectomy, the entire disc is removed. During an arthroplasty, the herniated disc is replaced with an artificial disc. In more severe cases of herniation, a spinal fusion may be necessary. During this procedure, two vertebrae are fused, using a bone graft and metal rod to stabilize the spine.