What is a herniated disc?
Intervertebral discs are pads of cartilage, filled with a jelly- like center, that cushion the bones of each pair of vertebra. These discs allow for movement and flexibility, hold the vertebrae in place and absorb shock. With injury or aging, the disc degenerates causing the softer jelly- like center to rupture. The jelly inside spills into the space where the affected spinal nerve exits the spine, irritating the nerve, causing severe pain, numbness and weakness. It may also be called a pinched nerve, bulging disc, slipped disc or ruptured disc.
A herniated disc can occur anywhere in the spine, but is most common in the lumbar spine (lower back). The material that makes up the disc degenerates as we age, the disc flattens and tears, causing the jelly- like center to be squeezed out into the spinal canal, and the ligaments that hold the disc in place loosen, so that even a minor injury or strain can result in a ruptured disc. Disc degeneration is common in people older than forty, but starts at an even younger age.
The pain of a herniated disc results from compression of the nerve. It is called radicular pain that can radiate to other parts of the body such as the leg, where it is called sciatica. Or it can radiate down the arm from a pinched nerve in the neck.
Symptoms of a herniated disc depend on the level of the spine where the herniation occurs.
Some people can have a herniated disc and no symptoms, while others will experience pain, weakness, and/or numbness.
If the disc is in the lower back, the pain typically radiates over the buttocks and down one leg into the calf. With movement, the pain will shoot into the leg so that even a cough or sneeze can put more pressure on the nerve. Sitting, driving and bending forward can make the pain worse.
Pressure on the affected nerves causes the muscles to weaken, and may cause a patient to stumble or impair the ability to lift or hold objects. It can also result in abnormal reflexes. If a patient’s neck or back pain radiates down the arm or leg and the limb is numb, tingling or weak, it is possibly a herniated disc.
The patient will receive a physical examination, and the physician may move the affected limb to check for reflexes, muscle strength, and sensation. This neurological exam may be all that is necessary to diagnose a herniated disc. Imaging tests may be ordered to identify other conditions, and to visualize the affected nerves.
Nine out of ten people with a herniated disc will find that conservative approaches relieve their pain. Conservative measure include rest, physical therapy and exercises, pain medications, anti-inflammatory medications, and muscle relaxants, and local epidural injections of steroid medications. Lifestyle changes (diet and exercise) may be recommended when the patient is overweight. The patient may be advised to avoid heavy lifting and practice good posture, exercise regularly, and stop smoking.
When conservative measures fail to resolve symptoms within six months, surgery may be necessary.
Microdiscectomy is surgery to remove all or part of the disc to remove the pressure from the nerve.
In Orange County California, patients with back or neck pain, can obtain a diagnosis and treatment plan by contacting South County Orthopedic Specialists and scheduling a consultation. Our Fellowship trained spine surgeons, including Dr. Bryce Johnson and Dr. Stephen Huo, are experts in the diagnosis and surgical treatment of herniated discs. SCOS experts strives for compassionate, personalized care and treatment options geared to the patient’s needs, and goals.