A herniated disc, also known as a slipped or ruptured disc, refers to a problem with one of the rubbery cushions (discs) situated between the individual bones (vertebrae) that make up the spine. A spinal disc is a little like a jelly donut, with a soft center encased within a tougher exterior. A herniation occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior. This can lead to nerve irritation, causing pain, numbness, or weakness in the body parts served by the affected nerves.
The spine is divided into different sections, each with a unique function and structure. The cervical spine refers to the neck area, consisting of the first seven vertebrae from the top. It’s responsible for supporting the weight of the head and allowing for its flexible movement. The lumbar spine is situated lower down the back and is composed of the next five vertebrae. The lumbar region supports much of the body’s weight and is involved in movements such as bending and twisting. Each region serves different functions and has unique characteristics that influence how conditions like herniated discs manifest.
Prevalence and importance of recognizing the signs early
It’s estimated that 20 to 35% of adults experience symptoms of a herniated disc at some point, with most cases occurring in the lower back (lumbar spine) but can also occur in the neck (cervical spine). They can affect anyone but are most prevalent in people aged 35 to 55, often due to age-related wear and tear known as disc degeneration. Recognizing the signs early is vital, as a herniated disc can lead to more serious complications like nerve damage if left untreated. Early detection allows for timely treatment, which can alleviate symp toms, reduce the need for surgery, and improve the quality of life.
Anatomy of the Spine
An outline of the structure of the spine
The human spine, also known as the vertebral column, is a complex structure composed of 33 individual bones called vertebrae, which are stacked on top of each other. These vertebrae are separated by intervertebral discs that act as shock absorbers and allow for spinal mobility.
Support for the body: The spine provides crucial support for the body, allowing us to maintain an upright position. Without a functional spine, basic activities like standing, sitting, and walking would be challenging, if not impossible. This rigid structure also enables us to perform a multitude of movements, including bending and twisting.
Protection of the spinal cord: Perhaps one of the most essential roles of the spine is to safeguard the spinal cord, a critical bundle of nerves that stretches from the base of the brain to the lower back. The spinal cord serves as a conduit for transmitting signals between the brain and the rest of the body, facilitating communication that allows for sensation, motor control, and autonomic functions like heart rate and digestion. Encased within the vertebral column, the spinal cord is shielded from potential injuries.
Structural composition: Structurally, the spine is composed of a series of interconnected bones known as vertebrae. Humans typically have 33 vertebrae, although this can vary slightly. These bones are not uniform; instead, they are grouped into distinct regions, each with different characteristics and functions.
Cervical spine: The cervical spine consists of the top seven vertebrae, making up the neck portion of the spine. These vertebrae are smaller, allowing for a wide range of motion while supporting the weight of the head.
Thoracic spine: This region consists of the next 12 vertebrae, located in the chest area. These vertebrae have points of articulation with the ribs, forming the rib cage that protects vital organs like the heart and lungs.
Lumbar spine: Composed of five vertebrae, the lumbar spine is in the lower back. These are larger vertebrae; built to bear the body’s weight and any additional loads we carry. This region is often a source of back pain due to its high load-bearing function.
Sacral spine: The sacral region, at the base of the spine, is made up of five fused vertebrae. These vertebrae form a triangle-shaped bone, the sacrum, that fits between the two halves of the pelvis and supports the weight of the upper body.
Coccyx: The final section of the spine is the coccyx, or tailbone, typically composed of three to five fused vertebrae. While the coccyx is often thought of as a vestigial structure, it serves as an attachment site for muscles and ligaments and helps support a person’s weight when sitting.
Each of these regions is uniquely designed to balance the needs of support, flexibility, and protection within its specific context in the body. Collectively, they form the spine, a truly remarkable structure in human anatomy.
The role of discs in the spine
Intervertebral discs consist of a tough, outer layer (annulus fibrosus) and a soft, gelatinous center (nucleus pulposus). They play a critical role in allowing movement of the vertebral column and in cushioning the vertebrae during activities like walking, running, and jumping.
Shock Absorption: Spinal discs, located between each pair of vertebrae, perform a critical role in acting as shock absorbers for the spine. Without these discs, our vertebrae would rub directly against each other, leading to pain, discomfort, and eventual deterioration of the bones. The ability of these discs to absorb shock is particularly evident during physical activities such as running, jumping, or lifting, where they buffer the impact that travels up the spine.
Composition of the Discs: Each spinal disc is intricately constructed with two main components that allow it to fulfill its role. The outer layer, or the annulus fibrosus, is a tough, fibrous ring of cartilage. This outer layer is robust and resilient, providing the necessary strength to hold the vertebrae together and resist the pressures that come with movement and weight-bearing.
Inside the annulus fibrosus is the nucleus pulposus, a soft, gel-like substance. This substance provides the cushioning effect and is highly compressible. When a force is applied to the spine, the annulus fibrosus tightens, causing the nucleus pulposus to compress and spread the force evenly across the disc, minimizing the impact on the spine.
Contribution to Flexibility and Range of Motion: Apart from shock absorption, spinal discs also play a vital role in the overall flexibility of the spine and its range of motion. The discs allow for bending and twisting motions by acting as pivot points between the vertebrae. They can compress and change shape to accommodate movements, thereby contributing to the spine’s incredible flexibility. The combination of strong annulus fibrosus and soft nucleus pulposus allows each disc to handle movements smoothly and efficiently, without causing damage to the vertebrae.
Without these crucial spinal discs, the vertebrae in our spine would not have the protection or flexibility they need to function effectively. It’s essential to keep them healthy through regular exercise, proper posture, and good nutrition to maintain our spinal health and overall wellbeing.
Read More: The best treatment of PLID/ Disc herniation / Disc prolapse in Bangladesh
The Pathophysiology of a Herniated Disc
How a Disc Becomes Herniated:
A herniated disc, also known as a slipped or ruptured disc, occurs when the soft, gel-like center of a spinal disc, the nucleus pulposus, pushes through a crack in its tough outer layer, the annulus fibrosus.
The nucleus pulposus may protrude partially or entirely through the annulus fibrosus, potentially irritating nearby nerves.
Why a Disc Becomes Herniated:
The exact cause of disc herniation can vary, but it is often attributed to age-related wear and tear, a condition known as disc degeneration. Certain factors, such as genetics, occupation, and lifestyle factors like smoking and physical activity, can also influence disc health.
With age, spinal discs lose some of their water content. This loss makes them less flexible and more prone to tearing or rupturing even with minor strain or twist.
Other factors can contribute to disc herniation, including:
- Improper lifting techniques: Using your back muscles instead of your legs to lift heavy objects can put excessive pressure on the lower back, leading to a herniated disc.
- Strenuous physical activity: High-intensity activities, especially those involving heavy lifting or twisting of the spine, can put undue stress on the discs, increasing the risk of herniation.
- Being overweight or obese: Extra body weight places additional stress on the discs in your lower back, making them more susceptible to herniation.
- Genetic predisposition: Some people inherit a predisposition to developing herniated discs.
The difference between a herniated disc in the neck (cervical) and lower back (lumbar)
A herniated disc can occur in any part of the spine, but the symptoms vary depending on the location. When a disc herniation occurs in the cervical spine (neck), it can cause symptoms such as neck pain, shoulder pain, arm pain, numbness or tingling in these areas, and possible problems with balance or coordination.
In contrast, a herniated disc in the lumbar spine (lower back) can lead to lower back pain, sciatica (pain that radiates down the leg), numbness or tingling in the buttock and leg, and muscle weakness. These differences in symptoms arise due to the varying nerve pathways in different parts of the spine that may be affected by the herniated disc.
Read More: 6 Tips for Relieving Pain From Herniated Discs or Disc Prolapse
Common Signs and Symptoms of a Herniated Disc
General symptoms common to both cervical and lumbar herniated disc
In both cervical and lumbar herniated discs, common symptoms include pain localized to the spine or radiating along the path of the affected nerve, numbness or tingling in the area served by the affected nerve, and weakness that can cause stumbling or impaired lifting and holding of items.
•Pain and numbness: Often felt on one side of the body. The exact location of the pain depends on where the herniated disc is. For instance, a herniated disc in the cervical spine may cause pain in the neck, shoulder, and arm, while a herniated disc in the lumbar spine might cause pain in the lower back, buttock, and leg.
•Radiating pain: This pain typically extends to the arms or legs. For example, a herniated disc in the lower spine (lumbar region) can cause sciatica, a sharp, shooting pain that radiates down the back of the leg.
•Pain that worsens with certain movements or positions: The pain can intensify at night, after standing or sitting, or with certain movements, especially those that involve bending over or turning the neck.
•Pain during short-distance walking: Even walking short distances can cause discomfort or pain.
•Muscle weakness: Unexplained muscle weakness can occur, impacting your ability to hold or grip objects, or causing stumbling while walking.
•Tingling, aching, or burning sensations: These sensations can be felt in the affected area, such as the part of the body served by the compressed nerve.
•Absence of symptoms: Notably, not everyone with a herniated disc will experience symptoms. It is entirely possible to have a herniated disc without symptoms if it’s not pressing on a nerve. These asymptomatic cases may only be discovered when undergoing spinal imaging for an unrelated reason.
Specific signs of a cervical herniated disc
A cervical herniated disc may cause symptoms that affect the neck, shoulders, chest, arms, and hands. These symptoms might include sharp pain in the neck; pain near or over the shoulder blades; pain that radiates down the arm to the fingers; numbness or tingling in the shoulder or arm; and possible difficulties with coordination, often causing clumsiness or dropping things requiring immediate medical attention.
Specific signs of a lumbar herniated disc
When a disc herniates in the lumbar region, the lower back, buttock, leg, and foot can be affected. Symptoms often include lower back pain, burning pain that radiates down the leg (commonly known as sciatica), numbness or tingling sensation in the leg and foot, and muscle weakness that can cause stumbling or difficulty lifting and holding items. In some severe cases, it can lead to loss of bowel or bladder control, a symptom which necessitates immediate medical attention.
Risk Factors for Herniated Disc
A. Age
Age is a significant risk factor for herniated discs. Disc herniation most commonly affects people between 35 and 55 years old. As people age, their intervertebral discs begin to lose water content, making the disc more susceptible to tearing or rupturing with even a minor strain or twist.
B. Occupation
Certain types of jobs may increase the risk of a herniated disc. Occupations that require physically demanding work such as lifting, pulling, bending, or twisting can contribute to the wear-and-tear on the spine, increasing the risk of a herniated disc. Additionally, jobs that require long periods of sitting or driving might also increase the risk due to prolonged pressure on the spine.
C. Lifestyle factors like obesity, smoking, etc.
Several lifestyle factors can increase the risk of a herniated disc.
1. Obesity
- Obesity increases the risk of a herniated disc because it puts extra stress on the discs in your lower back. The extra weight can cause the disc to push against the spinal nerves, leading to a herniated disc.
- Regular physical activity can help maintain a healthy weight, thus reducing the strain on your spine and decreasing the risk of a herniated disc.
2. Smoking
- Smoking can increase the risk of a herniated disc because it lessens the oxygen supply to the disc, leading to its rapid degeneration. Without sufficient oxygen, the disc’s ability to heal and regenerate is compromised.
- Moreover, smoking affects the body’s ability to absorb nutrients that are necessary for the healing process of the disc. This can slow down the recovery from a herniated disc and worsen the symptoms.
3. Sedentary Lifestyle
- Living a sedentary lifestyle, with little to no exercise, can contribute to poor disc health and increase the risk of a herniated disc. Inactivity can lead to weak muscles, which are less capable of supporting and stabilizing the spine.
- Regular exercise, especially activities that strengthen the muscles in your back, abdomen, and legs, can help prevent herniated discs. Stronger muscles provide better support to the spine, making it less susceptible to injuries and conditions such as herniated discs.
4. Additional Factors
- Other lifestyle factors, like improper lifting techniques or sustained bad posture, can also lead to a herniated disc. It’s important to maintain proper body mechanics and posture to reduce undue stress on your spine.
- Genetics can play a role as well. Some people are more predisposed to disc problems due to their genetic makeup. Knowing your family history can help you take preventive measures.
Diagnosis of a Herniated Disc
A. Medical history and physical examination
Diagnosing a herniated disc begins with a thorough medical history and physical examination. Your healthcare provider will ask about your symptoms, their severity, and when they began. They’ll want to know about any injuries or activities that may have triggered your symptoms.
During the physical examination, your healthcare provider will check your spine’s alignment and note any pain, limitation of movement, or loss of reflexes. The physical exam might include checking for areas of tenderness, range of motion, muscle strength, and sensation in your limbs.
B. Imaging tests like X-ray, MRI, and CT scan
If your healthcare provider suspects a herniated disc, imaging tests may be ordered.
1. X-ray
- X-rays may be used initially, but they can’t visualize the disc itself.
- They are useful to rule out other conditions such as a tumor or infection that might be causing similar symptoms.
2. MRI (Magnetic Resonance Imaging)
- MRI is typically the most effective imaging test for diagnosing a herniated disc.
- It provides clear images of soft tissues like discs and nerves.
- It can accurately show the location and size of the herniation.
3. CT (Computed Tomography) scan
- CT scan can also be used for diagnosing a herniated disc.
- It provides detailed cross-sectional images of the body.
- CT scan helps to determine the location and severity of the herniation.
All these imaging tests are used to provide a more accurate diagnosis and to plan the appropriate treatment for a herniated disc. The choice of imaging test will depend on the patient’s specific condition and the healthcare provider’s judgment.
C. Nerve tests
If your healthcare provider believes the herniated disc is affecting your nerves, they might order nerve conduction studies. An electromyography (EMG) can measure the electrical activity in your nerves and muscles, helping identify if there is nerve damage. A nerve conduction velocity (NCV) test can measure how well and how quickly your nerves can send electrical signals. These tests can help pinpoint the location of the nerve damage.
Read More: Self-diagnosis of lumbar intervertebral disc prolapse/PLID/Disc Herniation
Treatment and Management of a Herniated Disc
A. Non-surgical treatments like physical therapy, medication
1. Most people with a herniated disc do not need surgery. Non-surgical treatments can often help manage symptoms effectively. This may include over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics for more severe pain.
2. Physical therapy is another key component of herniated disc treatment. Physical therapy exercises can help to reduce symptoms and strengthen the muscles to support the spine better. A physical therapist can provide exercises to help decrease pain and improve flexibility and strength. These exercises may also improve posture and decrease the likelihood of future disc problems.
3. Epidural steroid injections, where corticosteroids are injected into the space around the spinal nerves, can also be used to reduce inflammation and pain.
B. Surgical treatments
Several types of surgeries are possible, including microdiscectomy and discectomy with spinal fusion.
1. Considerations for Surgery
•Surgery may be considered if non-surgical treatments are ineffective after six weeks.
•It may also be required if the herniated disc causes significant muscle weakness, loss of bowel or bladder control, or severe pain that interferes with daily life.
2. Types of Surgery
Microdiscectomy
•This procedure involves the removal of the part of the disc that is pressing on the nerve.
•It aims to relieve the pressure on the nerve and alleviate symptoms like pain and weakness.
Discectomy with Spinal Fusion
•This procedure involves the removal of the disc, followed by the fusion of the vertebrae.
•The vertebrae are fused together using bone grafts, screws, and rods to stabilize the spine.
•It can help reduce pain and improve the stability of the spine.
The choice between these and potentially other surgical procedures will depend on the specific patient’s condition, the location and severity of the herniated disc, and the surgeon’s judgement.
Importance of early diagnosis and treatment in reducing long-term effects
Early diagnosis and treatment of a herniated disc are crucial in reducing long-term effects. The longer a herniated disc is left untreated, the more damage can occur to the nerves, potentially leading to permanent issues such as chronic pain, decreased mobility, or even paralysis in severe cases. The sooner treatment begins, the better the chances of reducing pain and returning to normal activity.
By identifying and treating a herniated disc early, patients have a better chance of recovering fully with minimal long-term effects. Regular check-ups and following the treatment plan designed by the healthcare provider are crucial steps in managing a herniated disc.
Conclusion
Maintaining a healthy spine is important for preventing a herniated disc. Lifestyle modifications like regular physical activity, maintaining a healthy weight, practicing good posture, and avoiding tobacco can contribute to spine health. Also, if your job involves lifting, learn and follow proper techniques to prevent strain on your lower back.
Remember, your spine is crucial for almost every movement your body makes. Taking steps to keep it strong and healthy can have a profound impact on your overall quality of life.
FAQ’s
What are the common symptoms of a herniated disc in the neck or lower back?
Symptoms of a herniated disc can vary depending on its location and severity. For a herniated disc in the neck, symptoms can include pain that radiates to the arms or hands, numbness or tingling in the shoulder, arm, or hand, and potentially muscle weakness in these areas. For a herniated disc in the lower back, symptoms often include sciatica, a sharp pain that extends from the buttock down to the leg, numbness or tingling in the leg or foot, and muscle weakness in the leg.
What causes a herniated disc in the neck or lower back?
A herniated disc can occur as a result of aging, when the discs naturally degenerate and lose flexibility, making them more susceptible to rupture even with a minor strain or twist. Other risk factors include activities that put a strain on the spine such as lifting heavy items improperly, obesity which places additional stress on the discs, and genetics.
How is a herniated disc diagnosed?
A physical examination and discussion of symptoms can often lead a healthcare professional to suspect a herniated disc. To confirm the diagnosis, imaging tests like MRI or CT scans can be utilized. In some cases, nerve tests like electromyograms (EMGs) may be done to check nerve function.
How is a herniated disc in the neck or lower back treated?
Treatment usually begins with conservative methods, such as rest, physical therapy, pain medications, and possibly corticosteroid injections. If these measures do not alleviate symptoms or if the herniated disc is causing significant nerve damage, surgery may be considered. The type of surgery will depend on the location and severity of the herniation.
Is it possible to prevent a herniated disc?
While it’s not always possible to prevent a herniated disc, certain practices can lower your risk. These include maintaining a healthy weight, regular exercise (particularly exercises that strengthen the muscles supporting your spine), practicing good posture, and lifting heavy items properly by using your legs rather than your back.
Can a herniated disc heal on its own?
Yes, in many cases, a herniated disc can heal on its own over time. The body can reabsorb the herniated portion of the disc, and inflammation related to the herniation can decrease. However, the disc will always be somewhat vulnerable to re-herniation, and some people may continue to experience some level of ongoing discomfort or recurrent episodes.
Is it always necessary to have surgery for a herniated disc?
No, surgery is usually considered a last resort for treatment of a herniated disc. Most people with herniated discs respond well to conservative treatment methods, such as medication, physical therapy, and lifestyle changes. Surgery may be considered if conservative treatments do not alleviate symptoms after a period of time, or if the herniated disc is causing serious problems, like loss of bowel or bladder control.
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Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd
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