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Health See other Health Articles Title: Herniated Disc Medindia... What is Herniated Disc? Herniated disc is said to occur when the intervertebral disc protrudes into the spinal canal thereby compressing the spinal nerves and leading to severe lower back pain, as well as pain radiating to the affected limbs. Anatomy of the Vertebral Disc & Formation of Herniated Disk in Brief A vertebral disc refers to the rubbery disc located between two vertebrae that cushions the vertebrae and contributes to the vertebral column or the backbone. The interior of the disc is soft and jelly-like, while the exterior is tough. Sometimes, due to degenerative disc disease, the outer fibrous ring of the disk may rupture (ruptured disk) and the inner gel can leak into the spinal column. This leads to a herniated disc, which is often called slipped disc. The penetration of the herniated disc into the spinal column results in the narrowing of the spinal canal (spinal stenosis), and thereby exerts pressure on the spinal cord (spinal compression), causing severe pain. Herniation occurring anywhere along the spine is called spinal disc herniation. In case of herniation in the lower back or lumbar region (lumbar disc herniation), lower back pain occurs and the pain can sometimes radiate down the sciatic nerve, causing severe leg pain (sciatica). If the herniation occurs in the neck or cervical region (cervical disc herniation), severe pain occurs in the neck, shoulders, and arms. Herniated disc is a very common condition. It usually occurs in individuals in the age group 35-55 years. It is more common in men than in women. What Causes Herniated Disc? The following risk factors can cause a herniated disc: Sedentary Lifestyle: A sedentary lifestyle predisposes to development of a herniated disc. Regular exercise is required to keep the body toned, and prevent the occurrence of a herniated disc. Gender: Men are more likely to develop a herniated disc, which usually occurs in the age group between 35 to 55 years. Body Weight: Being overweight puts much more pressure on the lower back, thereby causing stress on the vertebral column, which can lead to a herniated disc. Bad Posture while Lifting: While lifting heavy weights, if the back muscles are used instead of the leg muscles, then there is a chance of developing a herniated disc. Twisting rapidly while lifting also has the same effect. Repetitive Strenuous Activities: Certain types of occupations involve repetitive strenuous activities like lifting, bending, twisting, pulling, and climbing. In the absence of proper posture maintaining techniques while performing these activities, a herniated disc may occur. Chronic coughing and prolonged driving hours increase the chances of lumbar disc herniation. Smoking: Smoking reduces the oxygen supply to the disc and can increase the chances of degeneration. Risk Factors That Cause Herniated Disc What are the Symptoms of Herniated Disc? Very often a herniated disc may not produce any symptoms. However, when symptoms do occur, they can be quite severe. Symptoms Due to Lumbar Disc Herniation: Back Pain: This is a common symptom of a herniated disc in the lower back or lumbar region. Sciatica: Severe pain can radiate down either leg, eventually reaching the ankles and feet. This type of pain is called sciatica or sciatic pain. Numbness/Tingling Sensation: This type of sensation can occur in the legs and/or feet when the sensory nerves are affected. Muscle Weakness: The legs can become very weak and unable to bear the weight of the body if the motor nerves are involved. Cauda Equina Syndrome: This is an extremely rare condition, which occurs due to compression of the spinal nerve roots and causes loss of bladder and/or bowel control. If this syndrome occurs, immediate surgical intervention is required. Symptoms of Herniated Disc Symptoms Due to Cervical Disc Herniation: Neck Pain: Neck pain is especially evident at the sides and the back of the neck. The pain can get aggravated when the neck is bent and turned around. Muscle Spasms: Spasms may occur in the muscles of the neck. Radiating Pain: Pain can occur near the shoulder blade, which radiates to the shoulder, arm, and even the hand and fingers. How do you Diagnose Herniated Disc? In order to diagnose a herniated disk, first your doctor will take a detailed Medical History, followed by a Physical Examination, which includes the following: Neurological Assessment: The doctor will assess the strength of the muscles in your thighs, ankles and toes. He/she will also check whether there is any sensory loss, which is indicated by numbness experienced while gently touching the feet. Additionally, the knee and ankle reflexes will also be assessed. Straight Leg Raised (SLR) Test: This is a special type of neurological test used for young people (below 35 years). Here, you will be asked to lie down on your back. The doctor will lift the affected leg upwards, keeping the leg straight without any bending at the knees. If you feel pain in the leg below the knees, you are most probably suffering from a herniated disc. If you test positive by the SLR test, you will be advised to undergo imaging and certain other tests to confirm the diagnosis. These are briefly described below: X-Ray: An x-ray of the spine is done to rule out any other causes of back pain, besides that due to a herniated disc. Magnetic Resonance Imaging (MRI): MRI scan can be used for clinching the diagnosis as it can detect the narrowing of the spinal canal due to herniation. It can also create detailed images of soft tissues like the intervertebral discs. Computed Tomography (CT) Scan: In case MRI cannot be done, the next best option is a CT scan, which can produce sliced images of the spinal canal and associated vertebrae to detect disc herniation. Myelography: In this technique a radio-opaque dye is injected into the spinal canal and images are taken to detect the location and size of the herniation. In this procedure, the imaging can be done using x-rays, MRI or CT scan. Electromyogram and nerve conduction studies: Electromyogram and nerve conduction studies may be performed to test which nerves are affected. What is the Treatment for Herniated Disc? Treatment for herniated disc may involve non-surgical interventions i.e. conservative therapy, which usually solves the problem. Otherwise, if conservative therapy is unsuccessful, surgery is considered as the next option. Conservative Therapy Medications: Medicines are used to relieve pain and inflammation. In case of moderate pain, over-the-counter (OTC) medicines like paracetamol alone, or in combination with ibuprofen, a non-steroidal anti-inflammatory drug (NSAID) is usually recommended. Another drug is naproxen, which is also a NSAID and has a similar action. In case of severe pain and inflammation, narcotics (codeine, hydrocodone, oxycodone, methadone) may be prescribed. Other medications include muscle relaxants to treat muscle spasms (baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, dantrolene), opioids (, hydromorphone, fentanyl), oral steroids (bethamethasone, prednisone, prednisolone, triamcinolone acetonide), and epidural injection of steroids (cortisone) may be used in certain cases. Physical Therapy: If the pain does not resolve by medication alone, then physical therapy may also be added to the treatment regimen. Some of these include deep tissue massage and hydrotherapy. Additionally, the patient may be advised some exercises to relieve pain and tension in the affected muscles. Prolonged bed rest is not advised. Physical Therapy may Help Treat Herniated Disc Surgery If conservative therapy fails to relieve the pain and inflammation arising from a herniated disc, lumbar decompression surgery may be considered. Usually, a microdiscectomy is the most suitable option. Microdiscectomy: This is a minimally invasive surgical procedure, where the surgeon uses a special type of microscope to provide a close-up view of the surgical field. In this procedure, the herniated portion of the disc is excised, thereby relieving pressure on the nerve root, which then slowly heals. Microdiscectomy is generally very successful and instantly relieves leg pain (sciatica) arising from a lumbar herniated disc. However, complete recovery may take up to several weeks. In case of the neck, along with discectomy, the neighboring vertebrae may be fused together (spinal fusion) to prevent movement at that level. What are the Complications of Herniated Disc? If the herniated disc is not treated, the following complications may occur: Pain: Chronic back pain (due to lumbar disc herniation) may occur, which can produce sciatica, resulting is severe leg pain. In case of cervical disc herniation, severe neck pain as well as pain in the shoulder and arms can occur. Loss of Sensation: Sometimes, there may be loss of sensation in the legs and feet. On the other hand, if the herniated disc is treated by surgery, the following complications may occur: Infections: Post-surgical infection can occur. Hematoma: Internal bleeding can cause the formation of a large blood clot, technically termed as hematoma, which can cause nerve compression and severe pain. Nerve Damage: This can occur due to inefficient planning and execution of the surgery. Recurrent Disc Herniation: This can occur if an adjacent portion of the disc breaks off and once again causes a herniated disc, which may require another surgery. Is it Possible to Prevent Herniated Disc? Although it may not be possible to entirely prevent herniated disc, certain precautionary measures can be taken to reduce the risks appreciably. These are briefly highlighted below: Maintain Good Posture: Practice a good posture at all times – while standing, walking, sitting and sleeping. Avoid sitting in one place for too long. Practice Proper Lifting Techniques: While lifting weights, do not bend at the waist but instead bend at the knees. Keep your back straight and use the lower limb muscles to lift the weight. Maintain Proper Weight: Maintain the correct weight for your height as excess weight puts pressure on the lower back. Exercise Regularly: Regular exercise is good for maintaining muscle tone and to increase the weight-bearing capacity of the muscles. While sitting for long periods, stretch as often as you can. Do not smoke: Since smoking can predispose to disc degeneration, avoid smoking. What is the Prognosis of Herniated Disc? The prognosis is generally good for people with herniated disc. Most people recover with conservative therapy within 6 weeks. Some however still have persisting pain and require surgical intervention. The prognosis of microdiscectomy is generally very good and most patients improve and completely recover within several weeks. Health Tips 1. Exercise regularly: Regular exercise strengthens the trunk muscles and helps stabilize and support the spine. Regular Exercise may Help Reduce the Risk of Herniated Disc 2. Maintain good posture: Always maintain good posture as this helps to reduce pressure on the spine and intervertebral discs. Keep your back straight and vertically aligned, especially while sitting for long periods. While lifting heavy weights, let your lower limb muscles (not your back muscles) do the work. 3. Maintain a healthy weight: Excessive weight puts pressure on the spine and discs and predisposes to disc herniation. 4. Eat a healthy diet: Consume a balanced diet with plenty of fiber, proteins and fruits. Drink plenty of water and avoid carbohydrates and fat in your diet. Post Comment Private Reply Ignore Thread
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