Herniated Disc occurs when the outer fibers of an intervertebral disk tear and the nucleus pulposus rupture into the spinal canal. Symptoms can include pain, numbness, or weakness. A doctor can usually diagnose a herniated disc by a physical exam. The doctor will ask about symptoms and check for reflexes, muscle strength, and sensitivity to light touch or pinprick.
A herniated disc often occurs when the fibrous outer layer of a spinal disk tears or ruptures, and the jelly-like core squeezes out. The resulting pinched nerve can cause pain, numbness, and weakness in your arms or legs. The symptoms may vary, depending on the position of the herniated disk and which nerves are affected. The most common symptoms of a herniated disc are pain in the neck or back that travels down an arm or leg. If the herniated disk is in the lower part of your spine (the lumbar region), you may also experience achy, stiff legs. The pain typically gets worse when you move or lift heavy items, and it can be aggravated by coughing, sneezing, or sitting for long periods of time.
Your doctor will perform a physical exam to determine the source of your pain and test for muscle weakness or numbness. During the physical exam, your doctor will ask you to perform certain movements and notice when your pain gets worse or better.
If your doctor suspects a herniated disk, he or she will order an imaging test. The most common imaging test is magnetic resonance imaging (MRI). This scan uses powerful magnets to create 3-D images of your body structures. It shows your spinal cord and nerve roots, allowing your doctor to see if the herniated disc is pushing on a nerve or narrowing the spinal canal (spinal stenosis). At CORE Orthopedics, we use an open MRI machine, which is less claustrophobic than traditional MRI machines.
Other tests your doctor may order include computed tomography (CT) and electromyography. CT and EMG show how well your nerves are functioning, and they can help identify the area of your neck or back that is hurting. A myelogram is a special test that involves injecting dye into your spine under X-ray guidance while you have a CT scan. The herniated disk will appear as a bright spot on the scan.
Nonsurgical treatment for herniated disks includes pain medication, a physical therapy program, and image-guided cortisone injections to reduce inflammation. If your pain is severe, your doctor may suggest surgery as the best herniated disc treatment option.
Often, pain and weakness are the first signs of a herniated disk. Your doctor will take a detailed medical history to understand your symptoms and how they started. Then a physical exam will be performed. Your doctor will test how strong your muscles are and where you feel the most pain. He or she will also test for muscle weakness and numbness.
A herniated disk can develop as a result of general wear and tear (disc degeneration) or from a sudden injury. The most common causes of herniated discs are lifting a heavy object or twisting while lifting something. The most common herniated disks occur in the lower back (lumbar area), though they can happen in the neck (cervical area). Herniated disks in the upper-to-mid back are rarer.
The most important step in diagnosing a herniated disc is for your doctor to perform a careful physical exam. Your doctor will examine your neck, shoulders, arms, and hands, as well as your lower back, hips, legs, and feet. Your doctor will also ask you about your past activities that might have led to your herniated disc. This information helps your doctor decide which parts of your spine may be involved and the most likely cause of your symptoms.
An MRI is usually the best way to diagnose herniated discs, especially when they occur in the lower back or neck. The MRI uses radio waves and a magnetic field to create images of the soft tissues in your body, including your spine. The MRI can show which disc is herniated, if there is any nerve compression, and whether bone spurs or spinal cord tumors are present.
In some cases, your doctor may also order an X-ray to look for other causes of your pain. The X-ray can help determine how healthy your bones are and how much room there is for your spinal nerves to move out of the spinal canal. Other tests your doctor might order include an electromyography to find out which nerves are affected by herniated disks and nerve conduction studies to see if there is any ongoing nerve damage.
In most cases, herniated disks in the neck (cervical) or lower back (lumbar) improve on their own within a few weeks. Resting, limiting activities, ice therapy and taking over-the-counter pain relievers should ease the symptoms. Your health care professional may recommend a prescription strength analgesic, such as aspirin or naproxen (Alleve, Naprosyn), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Nuprin) and celecoxib (Celebrex). Your doctor also may prescribe muscle relaxers or opioids for severe pain. Opioids aren’t usually used for long periods because of their potential side effects, including dizziness, nausea, confusion and constipation.
X-rays and computed tomography (CT) scans show the bones of your spine. The scans help your doctor find the cause of your pain by identifying indentations in the spinal column caused by herniated discs. Your doctor may also order an electromyography, which tests the electrical activity of your nerves. This can help pinpoint which nerves are involved in your pain.
Your doctor can help you manage your symptoms with physical therapy and injections. Physical therapy focuses on strengthening your core and the muscles that support your spine. Your doctor may also suggest a type of massage called deep tissue manipulation, which works the deeper layers of your muscles. Injections can provide quick relief of herniated disk pain. Your doctor may inject your spine with a corticosteroid, such as methylprednisolone (Medrol) or triamcinolone (Ketorol). These are powerful medicines that reduce inflammation and decrease swelling in the area around spinal nerves.
If pain relievers and physical therapy don’t relieve your symptoms, your doctor may decide to surgically treat your herniated disc. Traditionally, surgeons remove the damaged part of your spine and the herniated disk through a large incision in your back or neck. Newer procedures, such as microdiscectomy and laminotomy, allow your surgeon to do the same operation through a smaller incision.
The goal of minimally invasive surgery is to restore movement and function while minimizing complications. Your surgeon may use this procedure if you’re not a candidate for traditional surgery or if your herniated disk is causing serious symptoms, such as loss of control of your bowel or bladder.
A herniated disc is a common problem that often causes pain and discomfort. The most common herniated discs occur in the neck (cervical) and lower back (lumbar). Fortunately, there are steps you can take to help prevent herniated disk problems.
Maintaining proper posture when sitting, standing, walking or running reduces the risk of herniated discs. You should sit with your spine straight, keep your shoulders back and your head up. This reduces the pressure on the spinal discs, especially in the neck and lower back areas where herniated discs most commonly occur. Physically demanding jobs increase the risk of a herniated disk, particularly those that require repetitive lifting, pulling, pushing or bending. A sedentary lifestyle also increases the risk of herniated discs. This is because the spine becomes weaker and more prone to injury from repeated stress.
Using proper lifting technique can greatly reduce your risk of a herniated disc. Avoid bending at the waist and instead spread your feet apart for a wide base of support. Bending with the knees is also much safer than bending at the waist. If you have a job that requires frequent heavy lifting, try to learn proper lifting techniques.
Exercise is important for the health of your spine, but strenuous movements that put a lot of pressure on the back should be avoided. For example, if you play tennis or golf, you should avoid exercises that involve significant forward bending and twisting. Instead, choose low-impact exercises such as swimming, cycling and walking that place less stress on the spine.
Another important step in herniated disc prevention is avoiding a sudden increase in activity after a period of rest. This can put too much pressure on the spine and cause a disc to rupture.
The primary reasons people herniate a disc are because of injury or disease, but age plays a role as well. As we age, the spinal discs begin to degenerate and lose their water content, making them more prone to rupturing. A herniated disc occurs when the annulus fibers are damaged, allowing the soft inner nucleus pulposus material to bulge into the spinal canal or foramen.