Disc Herniation
A herniated disc, also called slipped disc or ruptured disc, is a condition caused from wear and tear of the cushioning discs present between the bones of the vertebral column. These discs act as shock absorbers while walking or running, and are made up of an outer tough layer (annulus) that surrounds a jelly-like center (nucleus). Disc herniation occurs when a part of the disc nucleus is pushed beyond the annulus through a rupture or tear. This displaced nucleus extends into the spinal canal, which passes through the entire vertebral column, and inflames and presses against the spinal nerves, causing pain.
Any part of the spine can be affected by a herniated disc, but it is most common in the lower back (lumbar spine).
Causes
Spinal discs are made up of 80% water and when the discs dry out, Disc herniation can occur. Other causes of disc herniation include:
- Age-related wear and tear
- Improper lifting of heavy objects
- Genetic Predisposition
Signs and Symptoms
Lower back pain is the first symptom experienced by many patients. Other signs and symptoms of disc herniation include:
- Numbness or tingling sensation in the leg
- Leg or foot weakness
- Sciatica, characterized by pain radiating to the leg
In rare instances, patients can experience loss of bowel or bladder control from a condition called cauda equina syndrome. This condition can occur when a nerve at the lower end of the spinal cord is compressed and is a medical emergency.
Diagnosis
Your doctor will first analyze your medical history and conduct a physical examination. Additional tests will be ordered by your doctor, including:
- Neurological examination to test muscle weakness, and strength of your thighs, ankles and toes
- Imaging tests including X-rays, CT and Magnetic resonance imaging (MRI) scans identify the location of herniation
- Myelogram shows the pressure on the spinal nerves
- Electromyograms measure the electrical activity of the nerve
Treatment
Your doctor will suggest conservative therapies as the first course of treating the herniated disc including prescribing medications, and referral to a therapist.
Your therapist will teach you exercises to strengthen your back and stomach muscles. Heat or ice therapy or neck or lower back bracing may also be recommended.
Your doctor may also recommend steroid injections into the space surrounding the spinal cord to reduce inflammation.
Conservative treatment works for many, usually getting them back on their feet in a month or two.
Surgery
Your doctor may suggest surgery based on your presentation as well as your response to conservative treatment measures. Some of the surgical procedures may include microdiscectomy, open discectomy, and prosthetic intervertebral disc replacement. The surgeries will be performed under spinal or general anesthesia.
