The vertebrae are cushioned by intervertebral discs which act as shock absorbers for the spine. The normal intervertebral disc is composed of a nucleus pulposus, at the center, surrounded by a fibrous ring known as annulus fibrosus. The nucleus pulposus is a soft jelly like substance that is well hydrated and acts like a shock absorber. Herniated disc is a condition in which the outer fibrous annulus of the intervertebral disc is damaged causing the soft gelatinous material, from the center, to protrude through the ruptured annulus resulting in nerve root and/or spinal canal compression. Herniated disc is also known as a bulging disc, slipped disc or ruptured disc.
Traumatic injury, aging, repetitive movements, wear and tear, smoking, poor diet, and being overweight may alter the structure and function of the disc.
The predominant symptom of a herniated disc is pain, which can range from mild to severe and is usually aggravated by movement.
The most common signs and symptoms of a herniated disc are as follows:
- Herniated disc in the lower back causes back pain that radiates to buttocks and legs
- Herniated disc in the upper back causes neck pain that radiates to the shoulders and upper arms
- Numbness or tingling sensation
- Muscle weakness
- Rarely, bowel and bladder dysfunction
An accurate diagnosis and an effective treatment plan are important for a successful outcome. Your doctor will usually diagnose a herniated disc based on your history of symptoms along with a physical examination and neurological examination. Your sensations, reflexes, and the strength of the muscles are evaluated. Imaging tests such as X-rays, MRI or CT scan may be used to confirm the diagnosis of a herniated disc. X-rays of the spine may be taken to locate the collapsed disc space. A CT and MRI scan provides detail of the discs, nerve roots, and bone structures in the spine.
Treatment comprises of conservative and surgical treatment options. The conservative treatment options such as anti-inflammatory and pain medications, activity modifications, muscle relaxants, physical therapy, spinal injections, certain types of braces, and acupuncture can help reduce pain and the associated symptoms. You doctor may recommend a combination of two or more treatment modalities to enhance the potential of success of the treatment.
Surgery is not always indicated for patients with herniated disc. Surgery is considered for patients with unstable spine or neurological dysfunction and patients with persistent pain that does not respond to conservative treatment. A minimally invasive spine surgery may be performed to remove the protruding portion of the disc. Spinal stabilization and fusion may be required to reduce the pain and stabilize the spine.
Your surgeon will discuss surgical options with you and recommend the appropriate treatment plan for you.