What is a herniated disc? What causes it?

Each disc of the spine is designed much like a jelly donut. As the disc degenerates from age or injury, the softer central portion can rupture (herniate) through the surrounding outer ring (annulus fibrosus). This abnormal rupture of the central portion of the disc is referred to as a disc herniation. This is commonly referred to as a "slipped disc."

The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumber vertebrae in the low back. This area is constantly absorbing the impact of bearing the weight of the upper body. This is especially important when we are standing or sitting. The lower back is also critically involved in our body's movements throughout the day, as we twist the torso in rotating side to side and as we hinge the back in flexion and extension while bending or lifting

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What are symptoms of a herniated disc?

The symptoms of a herniated disc depend on the exact level of the spine where the disc herniation occurs and whether or not nerve tissue is being irritated. A disc herniation may not cause any symptoms. However, disc herniation can cause local pain at the level of the spine affected.

If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation. This can cause shooting pain in the distribution of that nerve and usually occurs on one side of the body, referred to as sciatica. For example, a disc herniation at the level between the fourth and fifth lumbar vertebrae of the low back can cause a shooting pain down the buttock into the back of the thigh and down the leg. Sometimes this is associated with numbness and tingling in the leg. The pain often is worsened upon standing and decreases with lying down. This is often referred to as a "pinched nerve."

If the disc herniation occurs in the cervical spine, the pain may shoot down one arm and cause a stiff neck or muscle spasm in the neck.

If the disc herniation is extremely large, it can press on spinal nerves on both sides of the body. This can result in severe pain down one or both lower extremities. There can be marked muscle weakness of the lower extremities and even incontinence of bowel and bladder. This complication is medically referred to as cauda equina syndrome.

What is the treatment for a herniated disc?

Occasionally, disc herniation is incidentally detected when a test such as an MRI is performed for other reasons. If no symptoms are present, no particular treatment is necessary.

Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medications, anti-inflammation medications, local injection of cortisone (epidural injections), and surgical operations. In any case, all people with a disc herniation should rest and avoid reinjuring the disc. Sometimes, even people with relatively severe pain early on can respond to conservative measures, including physical therapy with an exercise regimen, epidural cortisone injection, and/or oral cortisone medication (such as methylprednisolone or prednisone), without the need for surgical intervention.

There are now a variety of surgical approaches to treat disc herniation. Each type of operation is customized to the individual situation and depends a great deal on the condition of the spine around the disc affected. Surgical options include microdiscectomy using small surgical instruments and open surgical repair (either from a posterior or anterior approach). Urgent operation can be necessary when cauda equina syndrome is present.

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