What is a Herniated Disc?
Vertebral discs are rubbery pads that sit between the vertebrae. When a vertebral disc ruptures, its soft center can press against the spinal cord and nerve roots, causing pain. This disc failure is called a herniated disc. Disc herniations may occur in the lumbar spine, cervical spine or thoracic spine.
What is a Verterbral Disc?
The discs between each pair of vertebrae act as “shock absorbers” for the spine. The discs also allow the spine to bend and twist. The outer layer of the disc is made up of a tough wall called the annulus. The inside of the disc has a soft gel-like center called the nucleaus pulposus.
Other Names for a Herniated Disc
A herniated disc may also be referred to as a ruptured disc, pinched nerve or a form of radiculopathy.
Herniated intervertebral disc, prolapsed intervertebral disc and herniated nucleus are all terms that refer to vertebral disc failures.
Herniated Lumbar Disc
Herniated discs occur most often in the lumbar spine. A herniated lumbar disc creates pain and numbness in the buttock and down the leg, commonly known as sciatica. Sciatica may also be referred to by its main medical term, radiculopathy. This is the most common symptom of a disc herniation in the lower back.
Depending on the location and severity of the disc herniation, symptoms may occur in the lower back, buttock, front or back of the thigh, the calf, foot and/or toes. If a nerve is not being affected, you may have a backache or no symptoms at all. A herniated lumbar disc typically affects only one side of the body and symptoms may range widely. They include:
- Dull or throbbing lower back pain
- Lower back stiffness and/or muscle spasms
- Leg pain radiating along the path of the large sciatic nerve in back of the leg
- Searing, radiating, sharp, or electric pain in one leg
- Numbness,weakness, and/or tingling in the leg, foot, and/or toes
- Drop foot – difficulty lifting the foot when walking or standing on the ball of the foot
- Pain following sitting or standing for a long time
- Intense leg pain when bending forward at the waist
A loss of bladder or bowel control, numbness in the saddle area, and/or weakness in both legs are signs of a rare but serious condition called cauda equina syndrome. Pressure and swelling of the nerves at the end of the spinal column can lead to paralysis and other permanent impairments if treatment is delayed.
Herniated Cervical Disc
The cervical spine is the second most common location for a herniation. Herniated discs most often occurs in men who are middle aged or older, frequently after physical exertion. A herniated cervical disc may be caused by the wear and tear of the disc due to aging, improper lifting techniques, sudden movements or trauma. Congenital spinal issues may also cause a cervical disc herniation. Symptoms include:
- Pain when turning the head or bending the neck
- Pain on one side of the body
- Pain that radiates down the arm or hand
- Burning, tingling or numbness in the shoulder, arm or hand
- Muscle weakness
- Changes in grip strength
- Neck pain and numbness that radiates into either arm.
- Numbness along the shoulder, elbow, forearm and fingers
Pain, weakness or numbness may go away on its own after weeks or months. However, this may be the initial injury that leads to degenerative disc disease.
Herniated Thoracic Disc
Discs rarely become herniated in the upper- to mid-back, but when they do, it is usually the result of degenerative disc disease or sudden trauma, like a fall or car accident. There may be pain in the upper back, or the pain may present itself in the belly or chest. Symptoms include:
- Pain that starts slowly
- Pain that gets worse after standing or sitting, at night, sneezing, coughing, laughing, bending backward or walking
- Weakness or difficulty lifting the leg or arm
- Pain, numbness, or weakness that subsides or improves over time
- Pain when turning the head or bend the neck
Treatment normally begins with a period of rest and pain medications, followed by physical therapy.
If pain persists, nonsteroidal anti-inflammatory drugs, narcotics and muscle relaxers can alleviate the pain, back spasms and inflamed nerves. Lifestyle changes such as exercise and proper diet are important for managing the pain, especially among overweight patients. Steroid injections administered to the back of the herniated disc can decrease pain and swelling for several months.
Minimally Invasive Surgical Techniques
In cases where noninvasive treatments do not alleviate symptoms, surgery may be necessary.
Anterior Cervical Discetomy Fusion: The herniated disc is removed through a small incision in the front of the neck. A bone graft replaces the disc, and as it heals, it forms a new bone mass called a fusion.
Micro-discectomy/Laminectomy: Through an incision that is less than ½ inch long, a surgeon removes the herniated part of the disc that is pressing on the spinal cord or nerve root.
In a laminectomy, the surgeon makes an opening in the lamina (vertebral arch) or removes posterior structures to relieve pressure on the nerve root.
Cervical Total Disc Replacement: The herniated disc is removed and replaced with an artificial disc.
Anterior Lumbar Interbody Fusion: The herniated disc is removed through a 3-5 inch incision in the stomach. A metal cage filled with bone graft replaces most of the damaged disc. The bone eventually grows through the cage, connecting the vertebrae and creating a fusion.
Posterior Lumbar Interbody Fusion: The herniated disc is removed through a small incision in the back. Bone is removed from the vertebrae, and the surgeon works through this opening to remove the disc. An implant filled with bone graft replaced the damaged disc. Screws and rods hold the implant in place to stabilize the healing bone graft until it solidifies into a fusion.
Direct Lumbar Interbody Fusion: The surgeon removes the herniated disc through a small incision in the side. A bone graft replaces the herniated disc and as it heals, it fuses the vertebrae.
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