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.

The lumbar section of the back is where the majority of herniated discs will occur.  The lumbar segments of the back are located in the lower back.  A lumbar herniated disc occurs when the inner gel-like material leaks out of the outer core.  A herniated disc in the lumbar section of the spine can put pressure on the spinal nerve root.  This will cause sciatica, which is pain that can shoot down the leg.

Nearly 90% of herniated disc in the lumbar area will occur at the bottom of the spine.  The spine is described in segments.  Most herniated discs occur in lumbar segments 4 and 5 (L4-L5), which will cause pain in the L5 nerve, or lumbar segment 5 and sacral segment 1 (L5-S1), which will cause pain in the S1 nerve.   Symptoms will depend on where the herniated disc is located within the Lumbar segments.

Symptoms for L5 Nerve Impingement

A herniated disc at this location can cause weakness when extending the big toe.  This weakness can run up into the ankle.  The top of the foot can experience numbness and pain.  Radiating pain can shoot up into the buttocks.

Symptoms for S1 Nerve Impingement

A herniated disc at this location can cause loss of ankle reflex.  It can also cause weakness in an ankle push off.  The patient is not able to do toe rises.  Pain and numbness can radiate down the leg to the sole of the foot or outside of the foot (Sciatica).

Sciatica and the Herniated Disc

It is important to understand that sciatica is a symptom, not a diagnosis.  Sciatica is a symptom of a herniated disc that has put pressure on the radiuclar nerve in the lower back.  The clinical diagnosis for a herniated disc protrusion that causes the sciatic symptom is called “radiculopathy”.   When pressure is put on this nerve from a herniated disc, leg pain can occur along with tingling, numbness, or weakness that will begin in the lower back and travel through the buttocks and down the large sciatic nerve in the back of the leg.

The symptom sciatica can be very painful and even debilitating.  However, while it can be extremely painful, it is not commonly known to cause permanent sciatic nerve damage.  Because the spinal cord is not located in the lower spine, a herniated disc in this area will not generally pose a paralysis threat.

Cauda Equina Syndrome

The conus medullaris is formed just below the spinal cord and near the first lumbar vertebra.  Just below the conus medullaris is a bundle of nerve roots called the cauda equina.   Cauda Equina Syndrome is a rare condition that can be caused by compression or inflammation of the nerve roots.

There are two sciatica symptoms to watch for in order to determine if the Cauda Equina Syndrome is present.   It is important to seek emergency medical care in the event that the weakness in the leg becomes progressive and if bladder or bowel incontinence or dysfunction occurs.

Symptoms of the lumbar herniated disc can possibly be relieved within 4 to 6 weeks with nonsurgical treatments.  If after this time there is still pain, surgical options may be discussed.

The thoracic herniated disc is located in the upper back.   Thoracic herniated discs are not as common as the lumbar or cervical herniated disc.  This is because there is generally less pressure and motion in this segment of the spine.

A thoracic herniated disc occurs when the inner gel-like substance of any of the 12 vertebral discs of the thoracic spine leaks out of the inside of the disc.  This puts pressure on a nerve root that creates upper back pain along with other symptoms, such as shooting pain or numbness.    The type of pain caused will depend on which nerve is receiving this pressure.  It will also depend on if the spinal cord itself has pressure being placed on it.

It is important to determine the cause of the thoracic herniated disc before treatment of upper back pain.  There are two sources that doctors will look at to determine which course of treatment to take.  These causes are classified as:

• Degenerative Disc Disease – Degenerative is associated with a slow and gradual wear and tear of the vertebral discs.   This is generally caused with age.   It is a very slow process, and patients will usually not feel the effects of the wearing and tearing until long after the onset of the degeneration.    Degenerative disc disease will generally be seen in people in their 40’s and 60’s.
• Thoracic Segment Trauma – When a trauma has occurred to the thoracic region of the back, a herniated disc can develop.   Symptoms will develop upon impact.   A fall or sports injury causing sudden force to the upper back could be a traumatic event that could lead to a thoracic herniated disc.    Younger patients can be exposed to a thoracic segment trauma herniated disc.

Symptoms Associated with the Thoracic Herniated Disc

The symptoms of a thoracic herniated disc will depend on the size and location of the herniated part of the disc.  There are general areas that a herniated disc can erupt, which are:  central, lateral, or centro-lateral.   The symptoms for each are as follows:

• Central Disc Protrusion – There is not much room under the spinal cord in the thoracic spine.  Therefore, when there is pressure from the thoracic herniated disc, pressure is put on the spinal cord and can affect this nerve.  This type of herniated disc will cause upper back pain.  It will depend on the size of the herniated disc and the amount of the pressure on the spinal cord as to the extent of the symptoms.  In severe cases, paralysis from the waist down could be a result.
• Herniated Lateral Disc – If a disc protrudes laterally, this is to the side.  The gel-like material will put pressure on the nerve that is located at that level of the spine and will likely cause radiation chest wall or abdominal pain.
• Herniated Centro-lateral Disc – A combination of symptoms can occur with this type of thoracic herniated disc.  This could be upper back pain, radiating pain, or Myelopathy, which is a functional disturbance or pathological change in the spinal cord.

While the thoracic herniated disc is not as common as the others, it still exists and can be painful.  It is important that the type of herniated disc is discovered to ensure proper treatment.