Herniated Disc

What is a Herniated Disc?

There are many different words that people use to refer to back pain related to a herniated disc, which includes slipped disc, bulging disc, ruptured disc, collapsed disc, or prolapsed disc.  Each term is similar in that it describes a spinal disc that is not normal and has weakened and presses outward on your spinal cord causing pain.  A herniated disc can be a very painful and debilitating injury that greatly diminishes a patient’s daily routine.  A herniated disc can cause severe painful symptoms in the back, legs and neck, shoulders, arms, and hands.  To a medical professional like a spine surgeon, the following are the three most common medical types of herniated discs:

• Contained Disc Herniation: A spinal disc that the nucleus is bulging or stretching the outer annulus, and has not pushed (herniated) through the annulus wall into the spinal canal.
• Extruded Disc Herniation:  A ruptured spinal disc in which the nucleus has broken through the annulus wall entering the spinal canal. This type of extruded disc herniation is still attached to the spinal disc.
• Sequestered Disc Herniation: A ruptured spinal disc, that has broken away from the spinal disc, and has migrated into the spinal canal.

Disc herniations are the most common diagnosis among spine-related abnormalities of the lumbar and cervical spine. The incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually and most common in people ages 30-60 years old. Males tend to be twice as likely to suffer from a herniated disc. Proper physical examination, medical history, X-ray, and MRI should be considered for an appropriate diagnosis of a herniated disc. The initial treatment of a herniated disc should be conservative, managed through medication and physical therapy, and sometimes pain management injections.  Surgical treatment is usually indicated if the pain is uncontrolled after 4 to 6 months or if there is a motor deficit, radicular pain, or if cauda equina syndrome is present.

Your spine is made up of 33 bones starting at the base of your head with 7 vertebrae in your neck called the cervical region, 12 vertebrae in your middle back called the thoracic region, 5 vertebrae in your lower back called the lumbar region, 5 in the sacral region, and 4 in the coccygeal region or tailbone.   The spine supports many functions in your daily life including your ability to stand upright, support and turn your head, the ability to walk or run, and turn or bend in multiple directions. In addition, the spine houses and protects the spinal cord and branching exiting nerves that extend into our arms and legs.  Strong bones and muscles, flexible ligaments and tendons, and nerves contribute to a healthy functioning spine. However, any of these structures affected by injury, disease or strain can cause pain.

In between each of these vertebrae is a shock-absorbing cushion called a disc which facilitates movement and minimizes friction. A herniated disc is one of the most common causes of neck, back or leg pain. This spinal condition is a result of pressure on the nucleus pulposus, the inner gel-like part which acts as a cushion, pushing through the annulus fibrosus, the outer wall of the disc. When this happens, the nucleus can bulge or herniate and begin to compress the spinal nerves causing significant pain in your back or legs called sciatica.  The spinal disc sits between each vertebra in your back and function as shock absorbers in the spine.  Damage to these discs referred to as degenerative disc disease can cause severe pain in the neck, back, and other areas of your body.  A herniated disc is very common in the neck (cervical spine), and low back (lumbar spine) and these conditions are treated every day with conservative care, spinal injections and sometimes surgical interventional with excellent results.