Spinal disc herniation: Symptoms, causes, treatment

A herniated disc is a condition in which the nucleus pulposus of the disc is displaced, compressing the nerve roots, causing pain and numbness. The disease can affect any part of the spine and is often caused by degeneration or trauma. Understanding the causes and timely treatment are key to protecting spinal health. 

What is a herniated disc?

The human body has a series of vertebrae in the spine, which extends from the base of the skull to the tailbone. Between the vertebrae are round cushions called discs. These discs act as cushions between the vertebrae, allowing the body to bend and move easily. When one of these discs tears or leaks, it is called a herniated disc.

According to statistics, up to 2% of the population suffers from a herniated disc each year. Herniated discs are the leading cause of neck pain, arm pain, back pain, and leg pain (sciatica).

A herniated disc can occur anywhere along the spine, but is most common in the lower back or neck. It is rare for a disc to herniate in the mid-back.

Causes of spinal disc herniation

The disc is made up of a gel-like nucleus pulposus and a harder outer layer called the annulus fibrosus that protects the nucleus.

Over time, the annulus fibrosus becomes damaged and can rupture or crack. A herniated disc occurs when the inner nucleus pulposus leaks through a crack in the annulus fibrosus and presses on nearby spinal nerves.

Other factors that can cause the annulus fibrosus to rupture and cause a herniated disc include:

• Aging: The natural aging process causes the disc to lose water, become stiff, and become vulnerable.
• Overwork or incorrect posture: People who regularly carry heavy loads or work in the wrong posture are at high risk of herniated discs.
• Trauma: Injuries to the back can cause herniated discs.
• Congenital or acquired diseases: Diseases such as scoliosis and spinal degeneration also increase the risk of herniated discs.
• Weight: A large weight index puts pressure on the discs, especially in the lumbar region.
• Unscientific living habits: Sitting in the wrong position at work, using pillows that are too high when sleeping, or being sedentary are also risk factors.

Symptoms of herniated disc

Symptoms of a herniated disc will vary depending on where the problem is in your spine and may get worse with activity but can be improved with good rest. 

Symptoms of a Lumbar Disc Herniation

A lumbar disc herniation often causes “sciatica” pain. This herniation pain is usually sharp and radiates down one side of the buttock to the leg or sometimes the foot.

Other symptoms of a lumbar disc herniation include:

• Back pain
• Muscle weakness
• Tingling or numbness in the leg or foot

Symptoms of cervical disc herniation

Symptoms of a herniated disc in the neck often include:

• Sharpening pain near or between the shoulder blades
• Pain that radiates to the shoulder, arm, and sometimes the hand and fingers
• Neck pain, especially in the back and sides
• Pain that increases when bending or turning the neck
• Numbness or tingling in the arm

Diagnosis

When arriving at a medical facility, the patient will be thoroughly examined by a doctor or medical professional to diagnose a herniated disc. Typically, during this process, the doctor will perform tests to assess pain, assess muscle reflexes, assess sensation, and assess muscle strength.

In addition, other in-depth assessments may also be required to diagnose a herniated disc, such as:

• Magnetic resonance imaging (MRI): The most common and accurate imaging test for suspected herniated discs is MRI.
• X-ray: X-rays help rule out other causes of back or neck pain.
• Computed tomography (CT) scan: A CT scan will allow detailed observation of the spinal bones and detect whether the herniated disc has moved into the space around your spinal cord and nerves and is pressing on them.
• Myelogram: This is a procedure that involves injecting a contrast dye into the spine using X-ray guidance for a CT scan. The dye can reveal spinal stenosis (narrowing of the spine) and the location of a herniated disc.
• Electromyography (EMG): This test involves placing small needles into different muscles and evaluating the function of the nerves. The EMG helps determine which nerves are affected by a herniated disc.

Treatment for spinal disc herniation

1. Home treatment

In most cases, the pain caused by a herniated disc in the spine will go away over time as the body gradually recovers. Initially, you can treat the pain at home with measures such as:

• Rest: One to three days if the pain is severe, but avoid lying in bed for long periods to prevent the risk of stiffness.
• Take over-the-counter pain relievers: Such as ibuprofen or acetaminophen. If you have special health conditions, you should consult your doctor before using pain relievers.
• Apply heat or cold: To the damaged spinal disc area, this should be done under the guidance of a specialist.

2. Advanced treatment

If the above methods do not improve the condition after 4-6 weeks, the doctor may advise the patient to perform advanced treatments including:

• Medication: The doctor may prescribe anti-inflammatory pain relievers or muscle relaxants.
• Physical therapy: The physical therapist will instruct the patient on exercises to help reduce pressure on the nerves, loosen contracted muscles and improve blood circulation.
• Spinal epidural injection: A minimally invasive procedure, using a small needle to inject Corticosteroid medication into the epidural space to help reduce swelling and nerve inflammation caused by a herniated disc. This will allow the spinal disc injury to heal faster.

3. Surgery

In rare cases, a large disc herniation can damage the nerves, bladder, or bowel. Emergency surgery is therefore necessary to prevent complications. In non-emergency cases, surgery may be indicated when other treatments fail.

There are different ways to perform surgery, but the overall goal is to relieve pressure on the nerves. Some common surgeries include:

• Discectomy: To remove the herniated disc. If the entire disc must be removed, the disc may be replaced with another piece of bone or an intervertebral cage that fuses two vertebrae together.
• Artificial disc replacement: Replaces a herniated disc with an artificial disc.
• Spinal fusion: Directly fuses two or more vertebrae together to stabilize the spine and reduce the risk of herniation.

When to see a doctor?

Here are some dangerous signs that you need to pay attention to and see a doctor for timely diagnosis and treatment:

• Urinary incontinence or urinary retention
• Increasing pain, numbness, muscle weakness
• Loss of sensation in the “saddle” areas, including the inner thighs, back of the legs, and the area around the anus
• Widespread pain, the pain may start at one point and spread to other areas such as the shoulder, arm, or leg
• Difficulty in movement: The ability to move is severely limited, which can lead to tripping or loss of balance

Prevention 

It is not always possible to prevent a herniated disc. But you can minimize the occurrence of symptoms by:

• Quit smoking
• Avoid wearing high heels
• Maintain a healthy weight
• Improve your posture when walking, sitting, and standing
• Stretch regularly if you have to sit in one position for a long time
• Exercise regularly, focusing on exercises that strengthen the back and abdominal muscles to support the spine.
• Use proper lifting techniques, limit bending at the waist, instead bend your knees, while keeping your back straight. This will help share the weight with more of the leg muscles.

In summary, a herniated disc can occur due to many different causes. Early detection will help the condition be treated effectively with conservative and non-invasive methods. If a herniated disc is left to progress for a long time, it can be the cause of many other pathological conditions in the body.