Herniated Disc – Symptoms, Causes, Prevention and Treatments

Herniated Disc | American Association of Neurological Surgeons

The bones ( vertebra ) that form the spine in the back are cushioned by disk. These discs are round, like small pillows, with a sturdy, out layer ( annulus ) that surrounds the lens nucleus. Located between each of the vertebra in the spinal column, disk act as jolt absorbers for the spinal anesthesia bones .
A herniated phonograph record ( besides called bulged, slipped or ruptured ) is a fragment of the disk lens nucleus that is pushed out of the annulus, into the spinal duct through a tear or tear in the annulus. Discs that become herniated normally are in an early degree of degeneracy. The spinal anesthesia duct has limited space, which is inadequate for the spinal anesthesia steel and the displace herniated phonograph record shard. due to this shift, the disk presses on spinal anesthesia nerves, much producing pain, which may be severe .
Herniated phonograph record can occur in any part of the spur. Herniated disk are more common in the lower back ( lumbar spinal column ), but besides occur in the neck ( cervical spinal column ). The area in which pain is experience depends on what separate of the spinal column is affected .

Causes

A single excessive strain or injury may cause a herniated disk. however, magnetic disk material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. As this degeneracy progresses, a relatively minor strain or twisting movement can cause a phonograph record to rupture .
Certain individuals may be more vulnerable to disc problems and, as a solution, may suffer herniated disk in several places along the spine. Research has shown that a predisposition for herniated disk may exist in families with several members affected .

Symptoms

Symptoms vary greatly, depending on the situation of the herniated disk and the size of the hernia. If the herniated disk is not pressing on a boldness, the affected role may experience a broken backache or no pain at all. If it is pressing on a heart, there may be trouble, numbness or weakness in the area of the body to which the boldness travels. typically, a herniated disk is preceded by an episode of humble back annoyance or a long history of intermittent episodes of humble back pain .
Lumbar spine ( lower spinal column ) : Sciatica /Radiculopathy frequently results from a herniated disk in the lower back. blackmail on one or respective nerves that contribute to the sciatic steel can cause pain, burn, tingling and apathy that radiates from the buttock into the leg and sometimes into the foot. normally, one side ( left or right ) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Straightening the leg on the affected side can much make the pain bad. Along with peg pain, one may experience first gear back annoyance ; however, for acuate sciatica the pain in the leg is often worse than the pain in the low back .
cervical spine ( neck ) : cervical radiculopathy is the symptoms of steel compaction in the neck, which may include boring or sharp pain in the neck or between the shoulder blades, pain that radiates down the branch to the hand or fingers or apathy or tingle in the shoulder or arm. The pain may increase with certain positions or movements of the neck .

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When & How to Seek Medical Care

fortunately, the majority of herniated disk do not require operation. With time, the symptoms of sciatica/radiculopathy better in approximately 9 out of 10 people. The time to improve varies, ranging from a few days to a few weeks .
General Guidelines

  • Limit activities for 2 to 3 days. Walking as tolerated is encouraged, along with an anti-inflammatory, such as ibuprofen, if not contraindicated for the patient. Bedrest is not recommended.
  • Primary care evaluation during this time may lead to considering other non-surgical treatments noted below, such as physical therapy.
  • Radiographic imaging, such as an MRI, is not recommended by the American College of Radiology, unless symptoms have been present for six weeks.
  • Referral to a spine specialist, such as a neurosurgeon, is also recommended if symptoms persist for greater than four weeks. A specialist will often want advanced imaging, such as the MRI, completed prior to the appointment.
  • Urgent evaluation and imaging is recommended if there are symptoms of significant leg/arm weakness, loss of feeling in the genital/rectal region, no control of urine or stool, a history of metastatic cancer, significant recent infection or fever AND radiculopathy or a fall/injury that caused the pain. Imaging should also be considered earlier for findings of progressive neurologic deficit (such as progressive weakness) on exam.

Testing & Diagnosis

Testing modalities are listed below. The most coarse imaging for this condition is MRI. Plain x-rays of the affect region are often added to complete the evaluation of the vertebra. Please note, a phonograph record hernia can not be seen on plain x-rays. CT scan and myelogram were more normally used before MRI, but now are infrequently ordered as the initial diagnostic imagination, unless special circumstances exist that warrant their use. An electromyogram is infrequently used .

  • X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc.
  • Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads X-rays; can show the shape and size of the spinal canal, its contents and the structures around it.
  • Magnetic resonance imaging (MRI): A diagnostic test that produces 3D images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots and surrounding areas as well as enlargement, degeneration and tumors.
  • Myelogram: An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.
  • Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury or whether there is another site of nerve compression. This test is infrequently ordered.

Treatment

Non-Surgical Treatments
The initial discussion for a herniated disk is normally cautious and nonsurgical. A doctor may advise the patient to maintain a low, painless activeness level for a few days to several weeks. This helps the spinal boldness inflammation to decrease. Bedrest is not recommended .
A herniated disk is frequently treated with nonsteroidal anti-inflammatory medication, if the pain is alone meek to moderate. An epidural steroid injection may be performed utilizing a spinal anesthesia needle under roentgenogram steering to direct the medication to the claim level of the disk hernia .
The doctor of the church may recommend physical therapy. The therapist will perform an in-depth evaluation, which, combined with the sophisticate ‘s diagnosis, dictates a discussion specifically designed for patients with herniated disk. therapy may include pelvic traction, ennoble massage, ice and inflame therapy, ultrasound, electrical muscle stimulation and stretching exercises. Pain medicine and muscle relaxants may besides be beneficial in junction with physical therapy .
Surgery
A doctor may recommend surgery if cautious treatment options, such as physical therapy and medications, do not reduce or end the pain wholly. Doctors discuss surgical options with patients to determine the proper procedure. As with any operating room, a affected role ‘s age, overall health and early issues are taken into consideration .
The benefits of operation should be weighed cautiously against its risks. Although a bombastic share of patients with herniated magnetic disk reputation meaning pain stand-in after operating room, there is no guarantee that operating room will help .
A patient may be considered a campaigner for spinal anesthesia surgery if :

  • Radicular pain limits normal activity or impairs quality of life
  • Progressive neurological deficits develop, such as leg weakness and/or numbness
  • Loss of normal bowel and bladder functions
  • Difficulty standing or walking
  • Medication and physical therapy are ineffective
  • The patient is in reasonably good health

Lumbar Spine Surgery
Lumbar laminotomy is a procedure often use to relieve leg trouble and sciatica caused by a herniated phonograph record. It is performed through a small incision down the center of the back over the area of the herniated disk. During this procedure, a helping of the lamina may be removed. Once the incision is made through the peel, the muscles are moved to the side so that the surgeon can see the back of the vertebra. A little open is made between the two vertebra to gain access to the herniated disk. After the disk is removed through a discectomy, the spine may need to be stabilized. spinal anesthesia fusion much is performed in conjunction with a laminotomy. In more involve cases, a laminectomy may be performed .
In artificial magnetic disk surgery, an incision is made through the abdomen, and the affect phonograph record is removed and replaced. entirely a humble share of patients are candidates for artificial phonograph record operation. The patient must have disc degeneration in only one magnetic disk, between L4 and L5, or L5 and S1 ( the first gear sacral vertebra ). The affected role must have undergo at least six months of treatment, such as physical therapy, pain medication or wearing a back brace, without showing improvement. The affected role must be in overall good health with no signs of infection, osteoporosis or arthritis. If there is degeneration affecting more than one disk or significant leg pain, the patient is not a campaigner for this operating room .
Cervical Spine Surgery
The aesculapian decision to perform the operation from the front of the neck ( anterior ) or the back of the neck ( buttocks ) is influenced by the accurate location of the herniated magnetic disk, deoxyadenosine monophosphate well as the experience and predilection of the surgeon. A share of the lamina may be removed through a laminotomy, followed by removal of the phonograph record hernia for the later approach. Patients, who are a candidate for posterior surgery, frequently do not need surgical fusion. For anterior operation, after the phonograph record is removed, the spine needs to be stabilized. This is accomplished using a cervical denture, interbody device and screws ( instrumentation ). In a choice group of candidates, artificial cervical disk is an choice vs. fusion .

Follow-up

The doctor of the church will give particular instructions after operation and normally prescribe pain medicine. He or she will help determine when the affected role can resume normal activities, such as returning to work, driving and exercising. Some patients may benefit from oversee rehabilitation or physical therapy after operation. Discomfort is expected during a gradual fall to normal action, but pain is a warning signal that the patient might need to slow down .

Resources for More Information

  1. 1. KnowYourBack.org. (2019). Herniated Lumbar Disc. https://www.spine.org/KnowYourBack/Conditions/DegenerativeConditions/HerniatedLumbarDisc

The AANS does not endorse any treatments, procedures, products or physicians referenced in these affected role fact sheets. This information provided is an educational service and is not intended to serve as aesculapian advice. Anyone seeking specific neurosurgical advice or aid should consult his or her neurosurgeon, or locate one in your area through the AANS ’ Find a Board-certified Neurosurgeon on-line tool .

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