A person suffering from lower back, arm, neck, or leg pain may be diagnosed with a herniated disc.  In order to truly understand what this means, it is important to know what a disc is made up of and what the functions are of a healthy disc.   A disc is made up of a tough outer core and a gel-like inner material.   A disc functions as a spacer, shock absorber, and motion unit.

Functions of a Healthy Disc

When it performs its duty as a spacer, this helps the intervertebral foramen maintain a height that allows room for the nerve roots to rest without compression.  They act as a shock absorber when a person decides to jump or run, allowing the spine to compress or rebound.  They act as a motion unit, so they allow a person to flex, bend, or rotate.

Brief Description of a Herniated Disc

A herniated disc occurs when the gel-like inner material breaks through the tough outer core and compresses on the nerves that are located outside of the disc.

Causes of a Herniated Disc

There are two main causes of a herniated disc.  Wear and tear due to age is common in older patients.   A traumatic injury is another cause that could also be found in younger patients.

Symptoms of a Herniated Disc

A person suffering from a herniated disc will feel symptoms in different areas of the spine.  The spine is divided into three sections.  These are:

• Cervical
• Thoracic
• Lumbar

When the nerves outside of the discs are pressed on, symptoms will occur, such as: pain, numbness, and weakness.  A common symptom is sciatica, which is most commonly found in the lower back.

Diagnosis of a Herniated Disc

Tests to be run for a herniated disc are a MRI or CT scan.  They can confirm a herniated disc or rule out any other problems.

Treatment of a Herniated Disc

Most people who are diagnosed with a herniated disc will not need surgery.   The first course of treatment will be a set of nonsurgical treatments that will be done for a period of four to six weeks.  Most herniated discs will begin to heal within this time period.

If they do not heal, surgical options may be discussed.  The traditional back surgery is not as common these days.  There are a couple of surgical options that will allow a person to have outpatient surgery without the risks of a traditional open back surgery.

Disc replacement surgery is also an option that requires a longer recovery period and has risks similar to the open back surgery.

Good Candidates for Herniated Disc Surgery

A doctor will take into consideration a number of factors that will help him/her determine if a patient will benefit from herniated disc surgery.

A herniated disc can be a painful and disabling health issue.  The good news is that most people can heal over a period of one to six months without needing surgery.  Even better news is that because of advanced technology, there are less invasive surgical treatments that allow a patient to feel relief on the same day of the procedure, as well as return to normal daily activities without pain in minimal time.

Artificial disc replacement surgery is a more invasive surgery.  The intended purpose of this herniated disc surgery is to restore the disc height while also restoring the physiologic motion that a person would have with a healthy disc.  Artificial disc replacement surgery is a type of joint replacement, which will involve inserting the artificial disc into the intervertebral space.   Therefore, the original unhealthy disc will be removed so that a new artificial one can be implanted.

The artificial disk is designed to function like a joint.  It will provide motion, such as:  flexion, extension, side bending, and rotation.  It will also provide height and curvature alignment to resemble the natural disc.

Understanding the Role of a Healthy Disc within the Spine

A healthy disc acts as a spacer, a shock absorber, and a motion unit.  When the disc is functioning as a spacer, this allows motion to occur.  Spacing is important because it allows the intervertebral foramen to maintain a specific height, which will allow room for the segment nerve roots to exit without pressure.

When it acts as a shock absorber, this will allow the spine to compress and rebound while the spine is preparing for activities, such as jumping and running.  It helps to resist the downward pull of gravity on the head and trunk when a person is sitting or standing.

When acting as a motion unit, the disc’s elasticity will allow motion, so the spinal segment can flex, bend, or rotate.  It will also allow the spine to bend to the side.

Benefits and Risks of Disc Replacement Surgery for a Herniated Disc

The most obvious benefits are that the spine can move.  Another benefit is that bone graft is not required.  When a patient has spinal fusion surgery as opposed to disc replacement surgery for a herniated disc, bone graft must be taken from the hip to pack the disc space.  This will leave two incisions that will need to heal.

There are a variety of risks that can be involved in disc replacement surgery.  As with any surgery, there are risks associated with anesthesia complications, blood clots, allergic reactions, as well as adverse effects from undiagnosed medical problems.

Other risks include:

• Allergic reaction to the material of the artificial disc replacement
• Artificial disc bends, breaks, loosens, or moves
• Surgical instruments bend or break
• Infections to the wound
• Neck pain
• Arm pain
• Swallowing difficulties
• Speech problems
• Possible impairment or paralysis due to nerve or spinal cord injury
• Numbness of extremities
• Loss of motion
• Protective membrane tear
• Swelling of tissue
• Pregnancy complications
• Not able to resume to normal activities

Unfortunately, the disc replacement surgery is not always successful.  There is a chance that this surgery will not relieve the pain or could even worsen symptoms.  Also, as with any surgical procedure, death is always a risk.

Recovery from this type of surgery is not easy and will likely require some type of physical therapy.  However, in time, the pain can be substantially reduced or completely eliminated, allowing a person to go back to his/her everyday activities.

The majority of the people who are diagnosed with a herniated disc are not in need of surgery.   Only about 10% of people diagnosed with a herniated disc will need to seek surgical options to relieve their pain.    The purpose for herniated disc surgery is to decrease the pain and allow the patient to move and function as normally as possible.

A doctor will consider the following before he/she makes a decision to operate:

1. Is there still continual leg pain that has not improved over a four week period of nonsurgical treatment?
2. Do the results of the physical examination currently show there is weakness, loss of motion, or abnormal sensitivity?
3. Does the diagnostic testing from an MRI, CT or Myelogram show that there is a herniated disc that can be treated surgically?

Other factors that will be taken into consideration before a decision for surgery is made:

• Age
• Overall health
• Severity of symptoms
• The impact symptoms have on patient’s life

Traditional Open Back Surgery (Traumatic)

Traditional open back surgery is an option that is slowly becoming less and less used as technology is becoming more advanced.  However, while there are other options for surgery, they may not be as effective for a patient’s needs.  For example, the option of disc surgery is not performed if the only symptom of the herniated disc is low back pain.

Disadvantages of Traditional Open Back Surgery (Traumatic)

• High risks
• Hospitalization
• Long and painful recovery time

Non-Traumatic Herniated Disc Surgery

The non-traumatic approach to remove herniated disc material is generally an outpatient surgical procedure that only requires a local anesthesia.  A small specially designed probe is inserted between the vertebrae and into the herniated disc space through the skin.   An x-ray fluoroscopy and a magnified video are used for guidance.

Traumatic Verses Non-Traumatic Discectomy

It is obvious that the non-traumatic discectomy is what is best for the patient.  There is less recovery time in a non-traumatic surgery because the incision is not as invasive.  There are no stitches needed.  After the probe is taken out, a band-aid will be placed over the incision.

In a non-traumatic discectomy, there is no bone removal or back muscle dissection.   The risk of complications is reduced dramatically.  There is less of a chance for scarring, blood loss, infection, and anesthesia related risks in a non-traumatic discectomy than in a traumatic discectomy.

Types of Non-Traumatic Discectomy

There are a variety of different non-traumatic herniated disc surgeries.  Many different doctors will offer different types of non-traumatic herniated disc surgeries.  They are considered non-traumatic as they do not require hospitalization and they are minimally invasive and have fewer risks than open discectomy.   There is the laser spine surgery and the Lumbar Endoscopic Discectomy, as well as the very common Percutaneous Endoscopic Discectomy.

It is recommended that a person research all options.  However, the non-traumatic has proven to be the best route to take.   Technology advances have made it possible for patients to endure herniated disc surgery without severe pain.  Check into all the options before making a decision.

A herniated disc could be the cause of mild to severe back pain.  The first step in determining the cause of back pain is to contact a doctor.  At this point, a doctor will perform an initial exam that will consist of a medical history and physical exam.

Initial Exam

After the medical history and physical exam are performed, a diagnosis of a possible herniated disc will be considered if there is irritation of one or more spinal nerves.   In this initial exam, if there is any loss of strength, sensation, or reflexes, the doctor will likely begin further investigation into determining if there is a herniated disc.  At this point, further tests and visits will be scheduled.  There will likely not be any more tests done during this visit.

Tests to Confirm a Herniated Disc

Imaging tests are used to confirm a herniated disc.   These tests are generally not performed unless nonsurgical treatments do not work to relieve the pain.  If there is still pain after four weeks of nonsurgical treatment, imaging tests will likely be recommended.   If the doctor is sure there is a herniated disc, these tests may not be needed.

Imaging Tests include:

• Magnetic Resonance Imaging (MRI) – This will confirm and show the location and severity of the herniated disc.  At this time, a doctor will look to make sure there is not some other serious condition, such an infection or tumor.   The images detailed in an MRI are of the soft tissues of the spine.  These soft tissues include:  muscles, spinal nerves, tendons, ligaments, discs, and marrow (the soft inner part of the bones of the spine).
• Computed Tomography (CT) Scan – This test will confirm and show the location and severity of the herniated disc, as well.  It can also look for other problems in the bones of the spine.  It can show detailed images of the bony structures of the spine.  This test is generally done if a person cannot have an MRI done.  For example, a person with a pacemaker cannot have an MRI performed.  It can also be performed if the results of an MRI are inconclusive.

For diagnosing a herniated disc in the lumbar spine (lower back), an MRI is preferred over a CT scan.  X-rays are not generally useful for diagnosing a herniated disc; however, a doctor may decide to have an X-ray or blood test done if there is no change in the pain after four weeks of nonsurgical treatment to rule out any other possibilities.

Other Test Options

The following tests can help to diagnose a herniated disc; however, they are not used as often for a herniated disc.  They could give the doctor more detailed information, if needed.

• Electromyogram and Nerve Conduction Test – Used to diagnose nerve and muscle disorder that could be performed on people who show signs of prolonged pressure on the nerve root.
• Myelogram – This is an X-ray of the spinal canal where a dye will outline the space of the spinal cord.  This test is combined with a CT scan and can be used if an MRI is not possible.
• Discography – In this test, a dye is injected into the gel-like center of the spinal disc to help diagnose disc problems.
• Nerve Root Block – A local anesthesia is injected next to the spinal nerve to confirm which nerve is being affected.

Once a doctor is certain of the diagnosis of a herniated disc, proper treatment options can be discussed.

Herniated discs are generally caused by wear and tear of the disc.  When a person ages, the vertebral disc will lose some of the fluid that helps keep the spine flexible.   Herniated discs are also caused by injuries to the spine.  This injury could cause tiny tears or cracks on the outer layer (Annulus Fibrosus).  The inner layer with the gel-like substance is forced though the tears or cracks causing the disc to bulge, rupture, or break into pieces.

Causes of Injury to the Spine

There are many activities or accidents that can cause an injury to the spine.   When there is sudden heavy strain or an increase of pressure to the lower back, a herniated disc can become worse.  Sudden twisting or even forceful sneezing can force the gel-like substance through the disc’s outer layer.

Repetitive activities that are stressful to the lower back can cause an aggravated disc to rupture.  This could include poor lifting habits, vibration exposure over time, or injuries from sports.

Herniated Disc Risk Factors

There are a variety of risk factors, some of which cannot be changed.  However, some risk factors could be prevented by simple changes.  Risk factors that cannot be changed are:

• Age
• Gender
• History

As mentioned above, age is a contributing factor to herniated discs.  Males are more prone to herniated discs.  The history of a person’s injuries to the back, previous herniated discs, and back surgery cannot be changed.

There are some risk factors that can be changed.  Taking the steps to reduce the risk from these factors can decrease a person’s overall risk of developing a herniated disc.  Lifestyle change and/or medical treatment could significantly decrease these risks.

Risk factors that can be changed:

• Job and Activities – Jobs or activities that can increase the risk of a herniated disc entail long periods of sitting or pulling heavy objects, frequent bending or twisting of the back, heavy physical exertion, repetitive back movement or an exposure to constant vibration.
• Strenuous Exercise – Strenuous exercise for a long period of time or exercising too hard after a long period of inactivity can increase the risk of a herniated disc.  Also, not exercising on a regular basis could increase the risk of a herniated disc.
• Smoking – Toxins found in Nicotine can keep the spinal discs from absorbing nutrients they need from the blood.  Smoking can also increase the sensitivity to pain.
• Overweight – Extra weight can put added strain on the lower back.

Herniated Disc Prevention Steps

The above risk factors can be decreased by taking the necessary prevention steps.    They are simple and can change a person’s risk of a herniated disc significantly.

• Maintain a healthy body weight.
• Exercise on a regular basis.
• Stop smoking.
• Use proper lifting techniques.
• Practice good posture.

Tips for Perfect Posture

• When standing or walking, keep shoulders back and down, chin down, abdomen in, and lower back supported.
• When sitting, use a small pillow or rolled towel to help support the lower back.
• When sleeping, keep back in a neutral position.  Use a towel roll to support the lower back or place a pillow under the knees.

Proper lifting techniques are important.  Lift by squatting and bending the knees.  Use the legs to push up.  Prevention is the key to lowering the risks of a herniated disc.