Herniated discs are one of the most common spine conditions. Herniated discs most often occur in the lower back, but can also occur in the upper portion of the spine. Herniated discs can put pressure on the spinal nerves, potentially causing symptoms in the arms or legs.
Fortunately, most instances of herniated disc can be treated without surgery, although there are surgical options available for those that do not find relief from nonsurgical treatment.
What is a Herniated Disc, and How Do They Occur?
Our discs function as shock absorbers within our spines. They are comprised of an outer ring of tough, flexible material called the annulus fibrosus and a soft, jelly-like center called the nucleus pulposus.
A herniated disc occurs when the material in the center of the disc pushes through the outer ring. This can happen due to a sudden injury or wear and tear to the disc over time. Many patients can recall a specific situation that caused the herniated disc, such as bending down to pick up a child or lifting a heavy item. Herniated discs are also common in athletes. However, some patients cannot recall any specific event.
To better understand what is happening, we often use a jelly donut as an analogy–if you squeeze a jelly donut, the jelly in the center of the donut will begin to leak out of the donut. Essentially, this is what is happening when a disc herniates; too much pressure can cause the center material to break through the outer ring of the disc.
Depending on the location of the herniated disc, back or neck pain is usually the first symptom. Herniated discs can put pressure on and irritate the spinal nerves, which can lead to pain, weakness, numbness, or tingling in one of the arms or legs. In very rare, severe cases, patients may experience loss of bladder or bowel control due to compression of the nerve root. However, some patients do not experience any symptoms at all.
Spine surgeons diagnose herniated discs by performing a thorough history and neurological assessment. In many cases, they will order X-rays and an MRI of the involved area to pinpoint the exact location of the herniated disc.
Treatment of Herniated Discs
Fortunately, most disc herniations can be treated without surgery. A short course of bed rest, activity modification, physical therapy, and anti-inflammatory medications are often all that is needed to relieve a patient’s symptoms. In some cases, steroid injections may be used to help with pain and inflammation.
If a patient’s symptoms do not improve or worsen after a course of nonsurgical treatment, or if a patient experiences loss of bladder or bowel function, these are considered “red flags” that indicate the patient will need surgical intervention.
The goal of surgery for a herniated disc is to take the pressure off the nerve and decompress the injured area. This is often done using a minimally invasive procedure called a microdiscectomy. With a microdiscectomy, the surgeon makes a small incision over the location of the herniated disc and uses an operating microscope or high-powered operating glasses, called loupes, to see the nerve root. This method allows the surgeon to perform the procedure without the need for a long incision, resulting in a shorter recovery time and less postoperative pain.
Once the surgeon has located the herniated disc, the protruding portion of the disc is removed, along with any materials that are compressing the nerve root. In rare cases, the entire disc may be removed, and vertebrae above and below the location of the disc are fused together. After treatment, most patients are able to gradually return to their normal activities with less pain and greater function.
If you suspect you have a herniated disc, seek the advice of a medical professional for a proper diagnosis. With the right treatment, you can return to your everyday routine without pain.