Herniated Disc

General

herniated disc refers to a problem with one of the rubbery cushions between the individual bones (vertebrae) that stack up to make your spine.

A spinal disc is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disc or a ruptured disc, a herniated disc occurs when some of the softer "jelly" pushes out through a crack in the tougher exterior.

A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disc. Most people who have a herniated disc don't need surgery to correct the problem.

Disc herniation is most often the result of a gradual, aging-related wear and tear, also called disc degeneration. As you age, your spinal discs lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Most people cannot pinpoint the exact cause of their herniated disc. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disc, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disc.

Symptoms

The most common signs and symptoms of a herniated disc are:

  • Arm or leg painIf your herniated disc is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disc is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
  • Numbness or tinglingPeople who have a herniated disc often experience numbness or tingling in the body part served by the affected nerves.
  • Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
Treatment

Conservative care, mainly avoiding painful positions and following a planned exercise and pain-medication regimen, relieves symptoms in 9 out of 10 people with a herniated disc. Painful discs that do not begin to improve within 3 days should prompt a visit to Novocur to evaluate treatment options such as:

  • Physical Therapy or Chiropractic Care. Physical therapists or Chiropractors can show you positions and exercises designed to minimize the pain of a herniated disc. Your provider may also recommend:
    • Heat or ice
    • Traction
    • Ultrasound
    • Electrical stimulation
    • Short-term bracing
  • Pharmacological Intervention
    • Over-the-counter pain medications.If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).
    • Narcotics. If your pain doesn't improve with over-the-counter medications, your doctor may prescribe narcotics, such as codeine or an oxycodone-acetaminophen combination (Percocet, Oxycontin, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs.
    • Nerve pain medicationsDrugs such as gabapentin (Neurontin, Gralise, Horizant), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Ultram) and amitriptyline often help relieve nerve-damage pain. Because these drugs have a milder set of side effects than do narcotic medications, they're increasingly being used as first line prescription medications for people who have herniated disks.
    • Muscle relaxers.Muscle relaxants may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects of these medications.
  • Epidural Steroid Injections (ESI). Inflammation-suppressing corticosteroids may be given by injection directly into the area around the damaged disc or spinal nerve roots. Spinal imaging is often necessary to guide the needle more accurately and safely.
  • Spinal Cord Implant Stimulator – Neuromodulation As a last resort, particularly following back surgeries that have failed to control back or leg pain, Spinal Cord Implant technology may be utilized to block the reception of pain.
  • A very small number of people with herniated discs eventually need surgery. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to experience:
    • Numbness or weakness
    • Difficulty standing or walking
    • Loss of bladder or bowel control
    • In many cases, surgeons can remove just the protruding portion of the disc. Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Rarely, your surgeon may suggest the implantation of an artificial disc.

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