What is a herniated disc and how does it occur?

Bones called vertebrae make up your spinal column.  These bones are stacked one atop of another.  In between these vertebrae are soft, rubbery structures called disks.  The disks act as cushions and shock absorbers during spinal movement.  Disks themselves are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus).  A disk herniates when part of the gel-like nucleus pushes through the outer annulus of the disk.  These herniated contents can then compress the nerves exiting the spine.

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Disks in the lumbar spine (low back) are the most prone to herniations given they bear the most weight.  Cervical spine (neck) discs are smaller and don’t bear as much weight, yet they are still prone to herniations.

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Some risk factors for herniated disks include activities that hyperflex the spine.  In the back, this may include someone improperly lifting something using their back instead of with their legs.  In the neck, this can be from a whiplash type injury from a car accident or sports such as football.  Other risk factors include obesity, smoking, jobs requiring a significant amount of sitting, and increased age.

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Symptoms:

Symptoms depend on the location of the herniated disks.  Herniated disks in the neck can compress the nerves in the neck.  Compression of these nerves can lead to pain in the neck, shoulder, and arm.  This arm pain is often shooting and described as burning, which is characteristic of nerve pain.   Patients may also experience arm/hand weakness, numbness, and tingling.

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Herniated discs in the lower back compress the nerves of the lower back and most commonly result in lower back, buttocks, and posterior leg pain.  The leg pain is also commonly shooting and described as burning.  Patients may also complain of leg/foot weakness, numbness, and tingling.

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One potentially emergent condition that can result from a large disk herniation in the lower back is Cauda Equina Syndrome.  In this condition, the large disk herniation severely compresses the large bundle of nerves at the end of the spinal cord.  Symptoms include loss of bowel or bladder function and numbness and tingling in the underwear region.  These symptoms are extremely serious and patients with Cauda Equina Syndrome must undergo emergent surgery to decompress the bundle of nerves.

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Diagnostic Testing:

An x-ray is usually first ordered to evaluate for fracture and other bony pathology, including baseline level of spondylosis (arthritis of the spine).  An MRI, however, is the study of choice for diagnosing a herniated disc.  An MRI is also helpful in ruling out other soft-tissue pathology that could be causing symptoms.

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Treatment Options:

Nonoperative treatment is usually effective in treating the symptoms of herniated disks in the vast majority of patients, as disks can heal on their own with time.  Treatment includes activity modification, weight loss, and a variety of medications (so long as there are no contraindications to taking those medications) that decrease pain and reduce inflammation.  Medications that directly target nerve pain may also be prescribed.  Physical therapy is also important to strengthen the supporting muscles of the spine.  Traction, a method of treatment designed to decompress the spinal disks and increase the room between the vertebrae, may also be recommended for those patients with herniated disks in the neck.  Last resort nonoperative treatment includes an epidural injection (injection around the irritated nerve itself) of a cortisone-like drug designed to reduce inflammation and swelling of the nerve. 

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Surgical Treatment:

 

Surgery is typically recommended only when nonoperative treatment measures have failed or the patient initially presents with significant weakness or persistent numbness.  These symptoms are usually indicative of a severely compressed nerve which needs to be decompressed in a timely fashion to avoid long-term sensation and motor deficits.  Surgery in the lower back usually involves removing the herniated part of the disk and any fragments placing pressure on the spinal nerve.  Surgery in the neck, given the disks are much smaller, usually involves removal of the entire herniated disk and the placement of bone in the disc space.  A metal plate may also be used to help support the spine.  If surgery is necessary, Dr. Steven Lee will refer you to one of his trusted spine surgeons.

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.