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Herniated Intervertebral Disc: The Basics.
Herniated Intervertebral Disc: The Basics.
Herniated discs are a common cause of lower back pain, probably not as common as people think, but hopefully this article helps to give a better understanding of the basic Anatomy, Symptoms, and some potential treatment options
What are Intervertebral Discs:
Intervertebral discs are fibrocartilaginous “cushions” located between the vertebrae of the spine. They serve as shock absorbers and allow for flexibility and movement in the spine. Each disc has a robust, tough outer layer called the annulus fibrosus (akin to our fingernails) and a “softer”, gel-like centre called the nucleus pulposus.
What’s Actually Happening:
A herniated intervertebral disc, incorrectly known as a slipped disc (another time!) or uncommonly a ruptured disc, occurs when the nucleus pulposus bulges or in the later case ruptures through a tear in the annulus fibrosus (bulging like a squeezed balloon in your hand). This can result (although less commonly than we used to believe) in compression or irritation of nearby nerve roots, leading to pain and other symptoms.
There are several factors that can increase the risk of developing a herniated disc (more detail another time!), including age, genetics, lifestyle, and less so occupation. As we age, the discs lose water content and can become less flexible, which we think makes them more prone to injury. Lifestyle factors such as smoking, obesity, and less so poor posture (what is good posture?) can also increase the risk of disc injury. Finally, occupations that require repetitive lifting, twisting, or bending while carrying load can put us at greater risk if we are not conditioned for the forces we put through our spine.
Some Common Signs and Symptoms of a herniated disc: (depending on the location and severity of the injury)
- Pain: This can be localised to the affected area or radiate to other parts of the body, such as the arms or legs. The pain may be dull, sharp, burning or electric in nature and can be aggravated by certain movements or positions which may lead to the pain “travelling away from the body, down the leg or down the arm).
- Numbness or tingling: This can occur in the affected area or in other parts of the body innervated by the compressed nerve root, such as the foot or hand. Numbness or tingling may be accompanied by a feeling of pins and needles or a burning sensation.
- Weakness: The compression may impact the innervation of certain muscles. This can affect muscle strength and coordination, making it difficult to perform certain activities. Weakness may be mild or severe and can be accompanied by muscle atrophy over time.
Loss of bladder or bowel control: This is a rare but serious symptom that requires immediate medical attention. It can indicate compression of the cauda equina, a bundle of nerves at the base of the spinal cord.
It's important to note that not all herniated discs cause symptoms, and some may even resolve on their own with conservative treatment such as rest, ice, and physical therapy. However, in cases where symptoms persist or worsen, further diagnostic testing such as imaging studies or electromyography may be needed.
Treatment for a herniated disc depends on the severity and duration of symptoms, as well as the patient's overall health and medical history. Conservative treatment options include:
Rest: Taking a break from activities that aggravate symptoms can help reduce inflammation and pain.
Ice or heat: Applying ice or heat to the affected area can help reduce pain and inflammation.
Physical therapy: A physiotherapist can design a program of exercises and stretches to improve flexibility, strength, and posture, and reduce pain.
Medications: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. In some cases, prescription medications such as muscle relaxants or opioids may be needed.
Epidural steroid injections: These injections can help reduce inflammation and pain in the affected area.
In cases where conservative treatment fails or symptoms are severe, surgery may be necessary. The type of surgery depends on the location and severity of the herniation, as well as the patient's overall health and medical history. Common surgical options include discectomy, laminectomy, and spinal fusion.