Overview of Herniated Disc

herniated disc4Often called a ruptured, bulging, or slipped disc, a herniated disc occurs most often in the lower back (lumbar spine). A herniated disc is one of the most common causes for low back pain and leg discomfort (sciatica).

The spine is made of 24 bones, called vertebrae. These vertebrae stack one on top of the other, and they connect to create a canal that protects and supports the spinal cord. When a disc bulges out of normal position, it can put pressure on the spinal cord, resulting in radiating pain, leg weakness, and numbness.

Causes of Herniated Disc

When a disc herniates, the jelly-like center (nucleus) pushes against the tough outer layer. When a disc becomes worn or is injured, the nucleus breaks (herniates) through the outer ring. The jelly-like material inflames the spinal nerves and puts pressure on these structures, resulting in pain.

For many people, a disc bulges as a result of the natural aging process. Normal spinal aging is called disc degeneration. However, a disc can herniated as a result of lifting, twisting, or bending. Risk factors for a herniated disc include:

  • Gender – Men between the ages of 30 and 50 are most likely to suffer a bulging disc.
  • Repetitive strain on the spine – Many jobs are physically demanding, requiring constant pulling, lifting, and bending activities.
  • Improper lifting technique – Use of the back muscles to lift heavy objects, rather than the legs, canherniated disc 3 cause a herniated disc.
  • Weight – Overweight and obesity puts added stress on the discs of the lower back.
  • Frequent driving – The vibration from a motor vehicle along with sitting for prolonged periods can contribute to disc herniation.

Symptoms and Diagnosis of a Bulging Disc

Most people who have a herniated disc complain of low back pain. The pain can last for many days, but will gradually improve. Low back pain is followed by the onset of leg numbness, weakness, and pain. This discomfort will extend to the area below the knee, and the foot and ankle can also be affected. Sciatica is the medical term used to describe the pain that moves from the back and buttock down the leg into the foot.

If the doctor suspects you have a herniated or bulging disc, he/she will conduct a physical examination and take a medical history. In addition, the doctor will order certain imaging tests. An x-ray is useful for determining spinal arthritis, and a magnetic resonance imaging (MRI) scan is used to evaluate the intervertebral discs.

Treatment for Herniated Disc

 

  • Medications – The doctor can prescribe topical medications, which are applied directly to the painful back region, or he/she can offer NSAIDS, short-term steroids, or opioid pain relievers.

 

  • Physical therapy – The therapist can teach the patient certain exercises to improve strength, flexibility, and motion of the spine.

 

  • Spinal decompression therapy – This is a form of negative pressure traction applied to the spine to allow the disc to reposition the bulging material. The lower disc pressure created allows healing nutrients to enter the disc.Lumbar_Transforaminal_Epidural

 

  • TENS unit – Transcutaneous electrical nerve stimulation is a unit that delivers electrical impulses directly to painful areas along nerve strands. The pulses impede painful signals from reaching the brain and stimulation the production of endorphins, which are natural painkillers.

 

  • Epidural steroid injection (ESI) – To alleviate pain, the doctor can inject a steroid with or without an anesthetic into the epidural space. The epidural is the layer of tissue right outside the spinal cord. With this procedure, there is minimal discomfort and immediate pain relief.

 

  • Trigger point injection (TPI) – This involves the injection of a local anesthetic, and sometimes a corticosteroid, directly into the soft tissue or muscle along the spine near the bulging disc.

 

  • Regenerative procedures – Collected from bone marrow or adipose tissue, adult stem cells are instilled into the disc to promote healing.

 

Resources

Manchikanti L, Cash KA, Pampati V, & Falco FJ. (2104). Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician, 17(4), 489-501.

Mayo Clinic (2014). Herniated disc. Retrieved from: http://www.mayoclinic.org/diseases-conditions/herniated-disk/basics/definition/con-20029957