What causes a herniated disc?
A herniated disc is a painful condition that can also contribute to numbness or weakness. This condition can occur naturally over time due to degeneration or suddenly due to an injury. Some herniated discs heal naturally.
What is a herniated disc?
Your spine is made up of 24 bones called vertebrae. Between each of these vertebrae is a shock-absorbing cervical disc that helps to cushion your spine. Your discs consist of an outer layer, known as the annulus, surrounding an inner layer, known as the nucleus.
A herniated disc occurs when the nucleus is pushed through the annulus and into your spinal canal. There is typically some spinal degeneration when a herniated disc occurs.
The majority of herniated discs occur in the five vertebrae that make up your lower spine, also known as the lumbar spine. The pain that you experience with a herniated disc is typically due to the disc pressing on a nerve.
If you have a herniated disc, you might experience symptoms such as:
- A persistent backache lasting more than a couple of days
- Numbness, tingling, pain, or weakness that radiates down your buttocks and legs
- A dull or sharp pain between the shoulder blades
- Numbness, tingling, pain, or weakness that radiates down your arms and hands
- Change in severity of pain with a change in position
Diagnosis for a herniated disc
Only a licensed healthcare professional can diagnose a herniated disc. If you are experiencing symptoms of a herniated disc, your doctor will perform a physical examination.
During this evaluation, you might be asked to walk on your toes and on your heels. Your doctor might check your reflexes and test how much sensation you are experiencing in your legs and feet. You might also undergo a neurological evaluation to check to see if you are experiencing any loss of strength or sensation in your muscles.
If you are experiencing sciatica, your doctor might perform what is called the Straight Leg Test. They will ask you to lie on your back while they lift the leg that hurts. Where you experience pain during this test helps the doctor assess whether or not you have a herniated disc.
If a herniated disc is suspected after performing basic tests, your doctor might order a magnetic resonance imaging (MRI) scan. This will provide a clear image of your spine and confirm the diagnosis.
Treatments for a herniated disc
Herniated discs typically heal without the need for surgery. It is likely that your doctor will recommend non-surgical options first.
Your doctor might recommend that you reduce your physical activity for a period of anywhere from a few days to a few weeks. This is to reduce the inflammation that is occurring near the nerves.
You might be advised to avoid bending and lifting anything heavy and to stop any physically demanding activities. Complete bed rest for more than two days is usually not recommended.
You may be prescribed a nonsteroidal anti-inflammatory drug (NSAID) for mild to moderate pain. If the pain is more severe, your doctor might recommend an epidural steroid injection. This injection takes place with an X-ray guiding the needle into the affected disc.
Physical therapy might be recommended for your herniated disc. This therapy focuses on exercises, stretches, massage, and other treatment options specifically tailored to help patients with herniated discs.
Your treatment plan may actually include a combination of physical therapy, rest, and medications.
If other treatment options do not work for you, your doctor may recommend surgery.
The most common surgical procedure performed for a single herniated disc is called a microdiscectomy. During this procedure, a small incision is made and the surgeon will work to remove the herniated part of the disc. If any other fragments are pressing on your nerves, they will remove those as well.
There are other surgical options for severely herniated discs or the herniation of multiple discs:
Possible complications and side effects
Though surgery is typically not suggested upfront, it is important to speak with your doctor. Try to come to an agreement regarding how long to try non-surgical options if you see no improvement in symptoms.
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American Academy of Orthopedic Surgeons: "Herniated Disc in the Lower Back."
American Association of Neurological Surgeons: "Herniated Disc."