Your spine (also called the spinal column or backbone), is made up of 26 individual bone discs called vertebrae, which are stacked one upon another. Between the vertebrae are flat, round cushioning pads called intervertebral discs, which provide the spinal column with flexibility, absorb shock during movement, and prevent the hard vertebrae from coming into direct contact with one another. Inside each disc is a soft, gel-like center — known as the nucleus pulposus — which is surrounded by a tough, fibrous exterior called the annulus fibrosus.
Sometimes pressure from the vertebrae above and below can force some or all of the nucleus pulposus to bulge out of place or squish out through a weakened or torn part of the annulus fibrosus. This is known as a herniated or ruptured disc. Once this happens, the soft, ruptured gel can press against the nerves near the intervertebral disc, causing pain, numbness and/or weakness.
Herniated discs most frequently occur in the lumber spine (in the lower back); however, they can also occur in the cervical (neck) and thoracic (upper back) spines. Depending on which disc becomes herniated, pain can occur in the back, arm, leg or neck.
Sometimes herniated discs occur suddenly by an injury or physical trauma of some kind. For example, a car accident, falling from a significant height and landing on your buttocks, improperly lifting an object, or trying to lift something that’s too heavy can all transmit a huge amount of force on the spine. When this happens, the spine may herniate.
Usually, though, disc herniation develops gradually with age. As we get older, the water content in our discs decrease, causing them to become weaker and less flexible, and more susceptible to wear and tear. Certain lifestyles or conditions can further deteriorate the discs, such as being involved in high impact athletic activities; routinely sitting, driving or squatting for long periods of time; tobacco use; and being excessively overweight or obese.
In some cases, there is no obvious reason why a herniated disc should have occurred. It could just be that one day you bend your back or twist your body in a manner that puts just the right amount of pressure on the disc to cause it to rupture through its worn-out exterior; the movement may not be excessive, but it is enough to be the proverbial “straw that breaks the camel’s back.”
Symptoms of a herniated disc vary depending on the size and location of the problem disc. With age-related disc herniation, patients typically start out experiencing a “twinge” in either their upper or lower back or neck (depending on whether the herniated disc is in the thoracic, lumbar or cervical spine), and then the pain gradually worsens over time.
Other symptoms indicative of herniated discs include:
Diagnosing a herniated disc begins with your doctor taking a complete medical history and a physical examination. You doctor will want to know your symptoms, how severe they are and when they started, along with what treatments you may have already tried. During the physical examination, you will be carefully examined for limitations of movement, problems with balance, loss of reflexes in the extremities, muscle weakness and other signs of spinal cord damage.
A definite diagnosis is made by various testing methods. This includes x-rays (to rule out other causes of back or neck pain), magnetic resonance imaging (MRI) or computed tomography (CT) scans (to check for narrowing of the spinal canal caused by a herniation), Myelogram (injection of dye into the spinal cord followed by a CT scan to pinpoint the size and location of the herniation), and electromyography (a test that measures electrical activity of the muscles).
Treatments of a herniated disc usually begin conservatively, and become more aggressive if the symptoms persist. Exactly which treatments are utilized depends on a number of factors including the patient’s symptoms, age and overall health, and whether the symptoms are worsening.
For most people, pain from herniated discs can be controlled with medication, and non-surgical treatments such as bed rest, limitations on physical activity, ice and heat applications, weight loss programs, use of a lumbosacral back support, physical therapy (massage, aerobics, stretching exercises, hydrotherapy, pilates, etc.), and osteopathic or chiropractic manipulations.
If the pain and/or other symptoms persist or get progressively worse, or if the pain is so intense that it cannot be controlled by the more conservative treatment options, surgery may be recommended to remove the herniated part of the disc and any tissue that is causing pressure on the nerve or spinal cord. This procedure is performed in the hospital under general anesthesia. Full recovery can take up to six weeks, and sometimes more.
There are also a couple different minimally invasive surgical procedures that may be done on an out-patient basis, to treat nerve compression from a herniated disc. .
Living with pain from a herniated disc can be a daily struggle, and interfere with your daily activities. It can be difficult to stand, walk, sit or even sleep comfortably. If your herniated disc symptoms linger for more than two weeks, it’s time to seek medical attention.
At Advanced Pain Consultants, we’re here to help you. Please call our office today at (919) 510-7901 to schedule an appointment with Dr. Pasi. During your consultation, she will evaluate your unique situation and develop an individualized treatment plan that is tailored for you. Don’t allow pain to run your life. Request your appointment today.