Overview The spine is composed of many vertebrae stacked
on top of each other. Between these bones are discs, which act as shock
absorbers. The shock-absorbing discs resemble jelly donuts, each having
a jelly-like center. As we age, the discs naturally become less flexible
and more brittle. Normal disc degeneration which naturally occurs with
old age, can also cause pain.
Discs can herniate in any direction--forward, centrally
or, most commonly, backward and sideways in the direction of the spinal
nerves.
Herniated discs account for a small percentage of back
pain.
While herniated discs are often referred to as “slipped
discs,” this really isn’t accurate because discs don’t
ever slip out of position. They are actually attached by connective
tissue to vertebrae above and below. A disc herniation can be “contained” or “uncontained.” With
a bulge, for example, the jelly center remains within the disc wall. "Uncontained" means
the jelly center has broken through the annulus wall but stays connected
to the nucleus pulposus. Or the herniation can be “sequestered,” when
it breaks free from the nucleus and travels away from the disc.
A bulging disc forms when the wall of the disc is deformed
but not necessarily herniated. The nucleus is still contained in the
wall. You NEVER need surgery to treat a bulging disc.
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Causes In the event of a fall or heavy strain, discs can
rupture, causing the nucleus to break through the wall of the disc
and place pressure on the nerves that branch out from the spinal cord.
This results in a herniated disc, accompanied by back or neck pain.
For example, sitting down for a while, then lifting a heavy object,
can cause a disc to herniate.
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Symptoms Sometimes, people mistake excruciating pain for
a herniated disc, when the pain might actually be the signal of a muscle
strain.
Because the nerve roots act as telegraph lines to other
parts of the body, a common complication of disc herniation is that
it can cause pain that is felt in other parts of the body. In fact,
leg pain below the knee is a common herniated disc symptom. This radiating
pain is called radicular pain or radiculopathy. Often, back pain without
leg pain can be a result of partial herniation of the disc or an internal
disc disruption.
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Diagnosis
Outlined below are some of the diagnostic tools that your physician
may use to gain insight into your condition and determine the best
treatment plan for your condition.
Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are
of limited value, however, since they do not show muscles and ligaments.
MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside
of your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very
safe and usually pain-free.
CT scan/myelogram: A CT scan is similar to an MRI
in that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A
local anesthetic is injected into the low back to numb the area.
A lumbar puncture (spinal tap) is then performed. A dye is injected
into the spinal canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup.
These tests, called electromyography (EMG) or somato sensory evoked
potentials (SSEP), assist your doctor in understanding how your nerves
or spinal cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton.
Bone scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are
performed to view the disc composition to determine if its structure
is normal or abnormal. In addition to the disc appearance, your doctor
will note any pain associated with this injection. The benefit of
a discogram is that it enables the physician to confirm the disc
level that is causing your pain. This ensures that surgery will be
more successful and reduces the risk of operating on the wrong disc.
Injections: Pain-relieving injections can relieve
back pain and give the physician important information about your
problem, as well as provide a bridge therapy.
Treatment Unlike muscles, which can heal somewhat quickly,
a torn or degenerated disc heals more slowly. The good news is that
in many cases, the pain and inflammation originating from damaged discs
can be treated nonsurgically by reducing the inflammation and by strengthening
the musculature surrounding the damaged disc to give it more support.
Special extension exercises can help relieve pain from
a herniated disc. Exercise can work like a vacuum to suck the center
of the disc back into place, helping release pressure on the nerve.
Although someone suffering an attack of back pain may find it hard
to believe, it has been proven that specific exercises can help relieve
their pain.
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FAQs What caused my disc to herniate? Herniated discs can occur as a result of a heavy
strain or fall, which causes the nucleus to break through the wall
of the disc and place pressure on the nerves that branch out from the
spinal cord. For example, lifting a heavy object after sitting down
for a long period of time can cause a disc to herniate.
What is the best way to treat a herniated disc? Nonsurgical treatment methods are always the best
option to try first. This will most likely involve working with a physical
therapist who will develop a customized exercise program involving
specific stretches and extension movements for you.
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