Disc Herniation

Miller School of MedicineState University of New YorkIowa State UniversityUniversity of IowaAANSNASSCongress of Neurogical Surgeons

Disc herniation describes a localized protrusion of the disc material outside the confinement and border of the disc. The disc is the “rubbery” cushion that sits between two adjacent vertebrae.

Several terms are used to describe spinal disc pain and spinal disc issues. Often, they are used interchangeably. Some of the most prevalent terms used include:

  • Herniated disc
  • Slipped disc
  • Degenerated disc
  • Torn/ruptured disc
  • Disc protrusion
  • Bulging disc

Herniated Disc

Degenerative Disc Disease

What Is Disc Herniation?

The disc is a spinal joint structure positioned between two vertebrae to provide support, stability, and mobility. A disc herniation, also known as a "slipped" or "ruptured" disc, occurs when the gel-like material inside the disc pushes out through a crack in the outer layer of the disc. Disc herniations can occur in any part of the spine, but they are most common in the lower back (lumbar spine) and the neck (cervical spine). They can put pressure on nearby nerves or the spinal cord causing symptoms and dysfunction.

Symptoms of disc herniation vary depending on the location and severity of the herniation. They may include neck or back pain, weakness in the arms or legs, numbness or tingling in the arms or legs, decreased range of motion, difficulty standing or walking for long periods of time, and bladder dysfunction.

A disc herniation can be caused by various factors such as age-related wear and tear, repetitive stress, poor posture, heavy lifting, or trauma such as a sports injury, a fall, or a car collision due to the sudden and forceful impact that the body experiences. In addition, smoking, obesity, and sedentary lifestyle increase the risk of disc herniation.

Treatment for disc herniation usually involves a combination of rest, physical therapy, pain medication, and in some cases, surgery. In many cases, symptoms can be relieved with conservative measures and the disc will heal on its own over time. However, severe or persistent symptoms may require more aggressive treatment, such as surgery to remove the damaged disc or to fuse the affected vertebrae together. If you experience symptoms of disc herniation, it is important to seek medical attention to determine the cause and appropriate treatment options. Early diagnosis and treatment can help prevent further nerve damage and improve outcomes.

Herniated Disc Surgery

DISC PAIN VERSUS PINCHED NERVE

There are two ways a spinal disc can cause pain:

Disc pain

The spinal disc itself can become the source of the pain if it degenerates or dehydrates to the point where it causes pain and spinal segment instability (this is called degenerative disc disease).

Those who suffer from degenerative disc pain often experience low-level and chronic pain around the disc. At times, episodes of severe pain are also experienced.

Disc Pain

Pinched nerve

The herniated disc itself will not cause pain. However, when the material that leaks out of the disc inflames, irritates, or pinches a nearby nerve, it results in radicular pain. Also referred to as nerve root pain, radicular pain is sharp and shooting pain that often radiates to other parts of the body. For instance, the pain can travel from the neck down to the arm or from the lower back down to the leg. Leg pain secondary to a pinched nerve is called sciatica.

Pinch Nerve

Disc Problems Diagnosis

The diagnostic process for both herniated disc and degenerative disc disease will include methods to confirm the disc as the pain source. The anatomy and mechanics of the pain will also be looked into. The good news is surgery for a herniated disc or bulging disc surgery is not always required. In mild cases, bulging disc treatment and herniated disc treatment will suffice.

Disc Problems Diagnosis

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Specific Symptoms and Medical History

Review Of Specific Symptoms And Medical History

Typically, the diagnostic process begins with a review of the current symptoms and the patient’s medical history. The following will also be taken into consideration:

  • The pain’s location and whether it is confined to the back or neck or if it travels to the leg or arm.
  • How the pain feels—if it is stabbing, dull, achy, sharp, or searing.
  • Whether specific positions, treatments, or activities can make worsen the pain or make it feel better.

Checking the patient’s complete medical background and history can also help identify and rule out other likely conditions that might cause pain. Information on dietary, exercise and sleeping habits is also typically collected.

Physical Examination

To accurately diagnose disc pain, one or a combination of the following tests may be done. The right diagnosis can also help determine the best herniated disc treatment or bulging disc treatment for a specific case.

palpation

Palpation

Palpating specific structures can help determine the pain source. For instance, severe pain when pressure is applied to the spine can mean sensitivity secondary to a damaged disc.

Movement tests

Movement Tests

Movement tests designed to assess the spine’s range of motion can include bending the torso or neck backward, forward, and to the side. In addition, if raising a leg in front of the body worsens the leg pain, it can be a sign of a lumbar herniated disc.

Muscle strength

Muscle Strength

A neurological exam may be carried out to determine if the nerve root is compressed by a herniated disc. It is also done to assess muscle strength. A muscle strength test can include holding the legs or the arms out to the front or side of the body. Doctors will also check for muscle atrophy, tremors, and other abnormal movements.

reflext test

Reflex Test

Nerve root irritation can affect the reflexes of the legs and arms. A reflex involves using a reflex hammer to tap into certain areas of the body. If there is minimal or no reaction, it can signify a compressed nerve root in the spine.

Nonsurgical Treatment Options For Herniated Disc Pain

Nonsurgical herniated disc treatment or bulging disc treatment is always the primary course of action for back pain, including pain secondary to a degenerative or herniated disc.

Nonsurgical treatment options can include:

  • Spine-specialized physical therapy
  • Massage therapy
  • Epidural steroid injections

In several cases, nonsurgical treatment options can relieve pain even without surgery.

Nonsurgical Treatment Options For Herniated Disc Pain
Surgical Treatment Options For Disc Pain

Surgical Treatment Options For Disc Pain

When conservative and nonsurgical treatment options won’t provide adequate pain relief, surgery may be considered. Spine surgery can only effectively alleviate pain if the degenerative or herniated disc seen on the MRI is confirmed as the pain source.

The following surgical procedures may be done to alleviate disc pain:

  • Artificial disc replacement
  • Spinal fusion
  • Microdiscectomy

Typically, spinal surgery is combined with a physical therapy rehabilitation program to maximize functioning and restore the patient’s range of motion after surgery.

MicroTubeTM Spine Surgery Treatment Option

MicroTubeTM Spine Surgery uses a minimalistic approach and allows excision or direct removal of the disc fragment through microdiscectomy. While most people use disc bulge and disc herniation interchangeably, technically, they are not the same. A disc herniation might lead to foraminal stenosis and lateral stenosis, and spinal stenosis. Click here to learn more about the benefits of minimally invasive MicroTubeTM Spine Surgery as a treatment for disc herniation and disc bulge.

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