Overview | Causes | Symptoms | Diagnosis | Treatment | FAQ
The spine is composed of many vertebrae stacked on top of each other.
Between these bones are discs, which act as shock absorbers. The
shock-absorbing discs resemble jelly donuts, each having a jelly-like
center. As we age, the discs naturally become less flexible and more
brittle. Normal disc degeneration which naturally occurs with old
age, can also cause pain.
Discs can herniate in any direction--forward,
centrally or, most commonly, backward and sideways in the direction
of the spinal nerves.
Herniated discs account for a small percentage
of back pain.
While herniated discs are often referred
to as “slipped discs,” this really isn’t accurate
because discs don’t ever slip out of position. They are actually
attached by connective tissue to vertebrae above and below. A disc
herniation can be “contained” or “uncontained.” With
a bulge, for example, the jelly center remains within the disc wall. "Uncontained" means
the jelly center has broken through the annulus wall but stays connected
to the nucleus pulposus. Or the herniation can be “sequestered,” when
it breaks free from the nucleus and travels away from the disc.
A bulging disc forms when the wall of
the disc is deformed but not necessarily herniated. The nucleus is
still contained in the wall. You NEVER need surgery to treat a bulging
In the event of a fall or heavy strain, discs can rupture, causing
the nucleus to break through the wall of the disc and place pressure
on the nerves that branch out from the spinal cord. This results
in a herniated disc, accompanied by back or neck pain. For example,
sitting down for a while, then lifting a heavy object, can cause
a disc to herniate.
Sometimes, people mistake excruciating pain for a herniated disc, when
the pain might actually be the signal of a muscle strain.
Because the nerve roots act as telegraph
lines to other parts of the body, a common complication of disc herniation
is that it can cause pain that is felt in other parts of the body.
In fact, leg pain below the knee is a common herniated disc symptom.
This radiating pain is called radicular pain or radiculopathy. Often,
back pain without leg pain can be a result of partial herniation of
the disc or an internal disc disruption.
Outlined below are some of the diagnostic tools that your physician
may use to gain insight into your condition and determine the best
treatment plan for your condition.
Medical history: Conducting
a detailed medical history helps the doctor better understand
the possible causes of your back and neck pain which can help
outline the most appropriate treatment.
Physical exam: During the
physical exam, your physician will try to pinpoint the source
of pain. Simple tests for flexibility and muscle strength may
also be conducted.
X-rays are usually the first
step in diagnostic testing methods. X-rays show bones and the
space between bones. They are of limited value, however, since
they do not show muscles and ligaments.
MRI (magnetic resonance imaging)
uses a magnetic field and radio waves to generate highly detailed
pictures of the inside of your body. Since X-rays only show bones,
MRIs are needed to visualize soft tissues like discs in the spine.
This type of imaging is very safe and usually pain-free.
CT scan/myelogram: A CT scan
is similar to an MRI in that it provides diagnostic information
about the internal structures of the spine. A myelogram is used
to diagnose a bulging disc, tumor, or changes in the bones surrounding
the spinal cord or nerves. A local anesthetic is injected into
the low back to numb the area. A lumbar puncture (spinal tap)
is then performed. A dye is injected into the spinal canal to
reveal where problems lie.
Bone scan: Bone imaging is
used to detect infection, malignancy, fractures and arthritis
in any part of the skeleton. Bone scans are also used for finding
lesions for biopsy or excision.
Discography is used to determine
the internal structure of a disc. It is performed by using a
local anesthetic and injecting a dye into the disc under X-ray
guidance. An X-ray and CT scan are performed to view the disc
composition to determine if its structure is normal or abnormal.
In addition to the disc appearance, your doctor will note any
pain associated with this injection. The benefit of a discogram
is that it enables the physician to confirm the disc level that
is causing your pain. This ensures that surgery will be more
successful and reduces the risk of operating on the wrong disc.
injections can relieve back pain and give the physician important
information about your problem, as well as provide a bridge therapy.
Unlike muscles, which can heal somewhat quickly, a torn or degenerated
disc heals more slowly. The good news is that in many cases, the
pain and inflammation originating from damaged discs can be treated
nonsurgically by reducing the inflammation and by strengthening the
musculature surrounding the damaged disc to give it more support.
Special extension exercises can help
relieve pain from a herniated disc. Exercise can work like a vacuum
to suck the center of the disc back into place, helping release pressure
on the nerve. Although someone suffering an attack of back pain may
find it hard to believe, it has been proven that specific exercises
can help relieve their pain.
What caused my disc to herniate?
Herniated discs can occur as a result of a heavy strain or fall, which
causes the nucleus to break through the wall of the disc and place
pressure on the nerves that branch out from the spinal cord. For example,
lifting a heavy object after sitting down for a long period of time
can cause a disc to herniate.
What is the best
way to treat a herniated disc?
Nonsurgical treatment methods are always the best option to try first.
This will most likely involve working with a physical therapist who
will develop a customized exercise program involving specific stretches
and extension movements for you.
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