What is a Herniated Disc?

A herniated disc is a condition which refers to a problem with one of the rubbery cushions (discs) that sit between the individual bones (vertebrae) that stack to make your spine. The discs between each vertebra (bone) in the spine act like shock absorbers when there is stress on the spine. If the soft inner portion of the disc presses outside of the disc’s tough outer layer, it forms a bulge (herniation). This bulge, the herniated disc, can press against nerves and cause mild to severe pain. Or no pain at all.

Herniated discs occur most often in the lower back (lumbar spine) or neck (cervical spine). Most herniated discs do not require surgery, but they often need treatment.

Signs and Symptoms

Signs and symptoms of a herniated disc can include:

• Numbness and tingling in the legs, feet, hands and arms
• Pain that shoots through the arms or legs when sneezing, coughing or changing positions
• Pain that ranges from annoying to severe
• Pain in the lower back, buttocks and thighs
• Pain in the neck that travels to the hands and arms
• Pain that gets worse when sitting, lifting, twisting or bending
• Pain that improves when walking or lying down
• Pain can come and go, lasting from days to months
• Weakness that affects any part of the legs or arms

The following symptoms related to a herniated disc require immediate attention:

• Bladder or bowel control problems
• The inner thighs, back of legs or area around the rectum lose feeling

Causes

Herniated discs are typically caused by wear and tear over time. As ligaments are used, it becomes more difficult to hold discs in place and instead allows discs to move in the spine. The causes of a herniated disc can include:

• Use of the back instead of the legs and twisting or turning to lift heavy objects
• Obesity can cause extra weight to stress discs in the lower spine
• Smoking

Risk Factors

Herniated disc risk factors can include:

• Age: Discs lose fluid over time.
• Family history:  In some cases, genetics can cause the spinal cord to form in a way that makes it easier for herniated discs to occur.
• Injuries: Blows to the spine from accidents, falls and violence can damage discs.        

Diagnosis

See a physician when symptoms are first experienced. Waiting to get a herniated disc diagnosis can lead to worse pain and nerve damage that causes numbness. A physician will do a thorough physical exam and ask about medical history and how and when pain first occurred. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic tests and procedures can include:

Imaging Tests

• CT scans: X-rays and computers can be used to create images of the spine and surrounding areas.
• Magnetic Resonance Imaging (MRI):A large magnet, radio waves and a computer are used to make pictures of the spine. A physician can look for loss of fluid in discs, enlarged joints, narrowed spinal canal (stenosis) or bulging (herniated) discs.
• Myelogram: Dye injected into spinal fluid creates contrast for X-rays to show pressure on the spine or nerves caused by one or several herniated discs.
• X-ray: A common imaging test used to look for decreased space between discs, breakdown of joints, bone spurs, hardened nerve bundles and spine problems when flexing legs or arms.

Nerve Tests

• Electromyogram: This test measures electrical activity in muscles when they are contracted or at rest.
• Nerve conduction study: This test can pinpoint the location of nerve damage and how fast nerves send electrical signals.

Prognosis

Prognosis for a herniated disc is good if diagnosed early and a person follows a treatment plan to manage or improve symptoms. Up to 80 percent of herniated discs heal and improve without surgery. Left untreated, pain can worsen.

Treatment and Recovery

Treatment for a herniated disc aims to lower or end pain symptoms and strengthen back muscles that support the spine. Treatment can include:

• Exercise: It is important to exercise gently to increase blood flow to nourish your back muscles. Your physician will tell you what exercises you can do. Exercise will also prevent bone loss (osteoporosis) and reduce the risk of fractures.
• Injections: Corticosteroid shots can block nerve pain and decrease swelling of a bulging (herniated) disc.
• Medication: Pain medications can be prescribed for mild to severe pain, inflammation, backache, muscle strain and tight muscles.
• Physical therapy: A physical therapist can teach the best ways to stretch and prevent muscle spasms, regain strength and improve posture. Heat and ice may be placed where pain is located to relieve symptoms. A brace may be used as a corset to keep the spine aligned. Water therapy may be recommended because water takes pressure off the spine.
• Rest: When the back is injured, it is important to rest immediately. Lie on a firm mattress with a pillow underneath the legs to take pressure off the spine. But do not stay in bed more than two or three days because back muscles will get weak. Get up and move around to get blood flowing to back muscles.
• Surgery: If other treatments are not effective and pain continues, surgery may be necessary. In some surgeries, tissue or bone that presses on nerves is removed. Sometimes, when the cause of the pain is removed, the spine becomes unstable. In some cases, another surgery is done at the same time to help bones grow together to make the spine sturdier. Another option for surgery is to replace a damaged disc with an artificial one. The new disc will cushion surrounding vertebrae and help the back or neck flex more easily. Lastly, in some cases when a neck disc is herniated, the spinal canal is reconfigured to make more room for the spinal cord.
• Recovery After Surgery: After surgery, your incisions may take one to two weeks to heal. Your surgeon will give you a plan to recover. It is important not to overdo it. If you get a fever, an infection or your pain increases, call your doctor immediately. You may need physical therapy after surgery to stretch your back and limbs and strengthen the muscles in your back to support your spine. As you gain strength, it is important to:
• Eat a healthy diet
• Exercise to increase blood flow to your back and limbs and improve your balance. This may be limited by doctor recommendations.
• Lose weight
• Stop smoking

Prevention

Herniated discs cannot be prevented when age or family history are risk factors. However, in most cases, you can take steps to lower your risk of herniated disc complications:

Be active: Moderate exercise helps circulation and helps strengthen bones and muscles.

Eat a healthy diet: Limit sugar, saturated fat, cholesterol and salt, and eat plenty of fruit, vegetables, whole grains and low-fat dairy products.

Get regular checkups: And, if you experience new or changing symptoms or side effects from medications, see your physician.

Lift properly: Protect your back and neck with proper lifting and bending form and by avoiding high-risk activity.

Stop smoking: Smoking damages blood vessels and reduces the amount of oxygen in the blood flow to heal and strengthen muscles.

Complications

Complications from herniated disc are not common, but occur in rare instances. In those rare instances, herniated disc complications can include:

• Bladder and bowel problems: Difficulties in controlling the bladder and/or bowel can occur.
• Decrease in flexibility: Stiffness can cause severe pain when trying to stretch the back or neck.
• Nerve pain or damage: Increased numbness, shooting pain in limbs or weakness in one or both legs can occur.
• Paralysis: Constant pressure (compression) on long nerve roots can permanently disable the affected area of the body.
• Weakness: The foot can drag (foot drop) if nerve damage weakens the leg muscles.

Baptist Health is known for advanced, superior care in diagnosing and treating a herniated disc. Our 24/7 inpatient neurology and neurosurgery services, as well as our outpatient services, Home Health, physical and occupational therapy services are available for treatment of herniated disc. In addition, we have the region’s only advanced 3Tesla, MRI, MRI spectroscopy and functional MRI technology to accurately diagnose all manner of neurologic disease, including herniated disc.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.