Herniated Disc - What is a disc herniation?

A disc herniation can be painful, or not. It can give you pain in the back, or in the arms or legs. It can be called a ruptured disc, a herniated disc, a slipped disc, a bulging disc or even a pinched nerve. All of these terms basically refer to the same thing. Disc herniation, along with the other terms, refers to the collapse of the cushioning pad that sits between the bones, the vertebrae of your back. The pressure of the vertebrae that occurs during a sharp movement or an accident can cause the center of the cushion, the nucleus, to be pushed out through in the annulus, the outer layer, into the spinal cord. Other factors that may contribute to a disc herniation are the degeneration of the bones of the spine caused by osteoporosis or other spinal deterioration conditions.

When the patient has disc pain in the back or legs that means that the pain is felt in the area of the disc herniation itself, and it is called axial pain. More often though, a patient will feel referred pain from the nerves that are pinched in the area of the spine where the bulging disc is located, and this is called radicular pain, or nerve root pain. When the disc herniation is located in the lower part of the back and the pain and tingling is felt in the legs, the condition is called Sciatica.

A disc herniation can happen anywhere in the back, although the lower back is the most frequent location, as that is where the majority of humans have their most movement – turning, bending and sitting. Please note that some people can have disc herniation and not even know it. When the muscles and tendons surrounding the herniated disc are strong, they can support the bone structure of the vertebrae to cause little pain. That is not to say, however, that later in life they will not feel the effects of the slipped or ruptured disc.

Your ruptured disc will be identified by its location on your back with a letter and a number. The neck area or cervical region will have the first five identifiers as C1-C7, for you have five joints in the neck. Next, joints in the thoracic region, upper back, will be called T-1-T-12, and the lower back joints will be identified as L-1-L5 for the lumbar region. Referred pain in the arms may occur from a ruptured disc in the cervical region, and referred pain in the legs is typically from disc herniation in the lumbar region. Your physician will most likely perform a CT scan, which shows a cross section of the spine, an MRI scan which reveals an excellent internal view of the anatomy of the spine including nerves, disc placement and bone heights. Another view can be captured with a discogram which can confirm for a physician where the pain is coming from and therefore confirm disc herniation. At the time of your first visit, your physician will also want to get an accurate history of the start of the pain, where the pain is located, what activities aggravate the pain, and how the pain feels. In addition, the doctor will also ask about any medicines you are taking, previous surgeries and any accidents. Nerve function with the reflex hammer, muscle strength and movement for pain will be looked at by your doctor during the physical exam, and then he can make a diagnosis.

Rest, rest, rest are the first words of advice for a person with disc herniation. When you have an aggravated disc, any movement that increases the pain will only prolong it. This is not to say that you should avoid all movement, because then stiffness will set in, but it means to not sit, stand or lie down in a position that causes pain while you are resting. Fortunately, many disc herniations will heal over time when treated appropriately. When a back disc is ruptured, the muscles surrounding the area may go into spasm and be painful. In this case, ice wrapped in a towel and a heating pad, alternating with no more than 20 minutes at a time for either, will help the muscles relax and provide relief. Over-the-counter anti-inflammatory and pain relieving medications are also helpful.

When the pain is severe and not helped by the above methods, your doctor may prescribe physical therapy, stronger narcotic pain killers or oral steroid medications. And if the oral steroids are ineffective or the pain is too severe, an injection of cortisone, a steroid, may be administered directly into the spine. Spinal decompression, in which the spine is gently pulled in traction to relieve pressure, is another method of treatment that is non-surgical.

Surgery is chosen only after more conservative methods have been exhausted or if there is severe neurological damage, or if other medical conditions are present. Several types of disc surgery exist, and can be performed on a minimally invasive method to lead to the least disruption of lifestyle.