Herniated Disc

What is a Herniated Disc?

A herniated disc is when the cushion between two vertebrae in the spine bulges out, putting pressure on the spinal cord or nerves.

An adult spine has twenty-six vertebrae between the base of the skull and the tailbone. They are separated by discs that act as cushions between the vertebrae. That cushioning keeps the vertebrae from rubbing together and allows your spine to easily move and bend.

Each disc has a gel-like interior and a more rigid outer layer. A disc becomes herniated when the gel-like interior pushes through a crack in the outer layer. The part that bulges through the gap can press against the spinal cord or nearby nerves. The disc can also leak fluid, which can irritate nearby nerve roots.

Any disc can become herniated, but it is most common in the neck or lower back. It’s one of the most common reasons for neck, back, and leg pain.

A herniated disc is also called a slipped, ruptured, or bulging disc.

Herniated Disc Symptoms

The symptoms vary depending on its location in your spine. Even though the disc is in your spine, you may have symptoms in other parts of your body if the herniated disc compresses a nerve root.

That’s because each nerve root carries signals to other areas of the body. For example, the pain and tingling of sciatica can be caused by a herniated disc compressing the sciatic nerve root.

Symptoms tend to get worse with movement and better with rest. They may include:

• Pain in your neck, back, shoulder, buttocks, hip
• Radiating pain
• Muscle weakness
• Muscle spasm
• Tingling or numbness

Causes

Disc herniation is commonly caused by disc degeneration, which is gradual wear-and-tear due to aging. Other possible causes include:

• Certain motions
• Twisting or turning while lifting an object
• Lifting a large, heavy object
• Trauma
• Certain lifestyle factors can increase your risk of suffering a herniated disc, including:
• Age
• Weight
• Smoking
• A sedentary lifestyle
• Jobs that require a lot of lifting

Diagnosis

A physical exam and your medical history are usually enough information to diagnose a herniated disc. The physical exam may also include a neurological exam.

Your doctor will assess your:

• Pain
• Reflexes
• Sensation
• Muscle strength
• Ability to walk

Your doctor may also order tests to rule out other problems and to get more information about your spine:

• Magnetic resonance imaging (MRI) – a test that uses a magnetic field and radio waves to create a picture of your spine
• X-rays – to make sure there’s not another cause of your pain
• Computed tomography (CT) – a test that shows the bones of your spine
• Myelogram – a test where dye is injected into your spine to show the location of the affected disc and any narrowing in the spinal canal (spinal stenosis)
• Electromyogram (EMG) – a test that uses small needles placed into specific muscles to evaluate which nerve is affected by the herniated disc
• Nerve conduction study – a test that measures electrical nerve impulses to help locate nerve damage

Treatment

Treatment usually depends on how far the disc has slipped out and how much discomfort you’re experiencing. Most people heal on their own with rest.

If symptoms don’t improve or get worse, your doctor may recommend:

• Avoiding activities that cause discomfort
• Heat or cold packs
• Stretching
• Physical therapy
• Aquatic therapy
• Traction
• Over the counter pain relievers
• Muscle relaxers
• Nerve pain medications
• Prescription pain relievers
• Epidural or facet joint injections
• Surgery

If not treated, a severely herniated disc could lead to permanent nerve damage. It may also lead to saddle anesthesia, a condition where the disc presses on nerves that cause you to lose feeling in your inner thighs, backs of your legs, and rectum.

Should I be on bed rest until I feel better?

Short rest periods are acceptable, but too much bed rest can cause stiff joints and weaken your muscles, making recovery more difficult. It’s better to alternate gentle activities with rest.

Will I need surgery?

Most herniated discs don’t require surgery. Resting your back is usually the first step in the treatment process. Surgery may be an option only if other treatments don’t relieve your symptoms.

What are some tips to reduce my risk of getting a herniated disc?

• Exercise to strengthen your muscles
• Maintain a healthy weight
• Don’t sit for long periods; take breaks to move and stretch
• Always use safe lifting techniques

Shane Mangrum, MD

Christopher Tomaras, MD

David Tran, MD

Raymond Walkup, MD