Herniated disc

The vertebrae that create the spine in the back are shielded with discs. These discs are round, small pillows with a hard outer layer surrounding the nucleus. These discs are present between each vertebra in the spinal column; discs act as a back and spinal bone shock absorber. A herniated or ruptured disc is a particle of the disc nucleus forced out of the annulus into the spinal canal by a rupture in the annulus. Discs become herniated gradually in the early stages of degeneration. The spinal canal has less or limited space, insufficient for a spinal nerve and the dislocated or displaced herniated disc fragments. Due to this dislocation, the disc presses or suppresses the spinal nerve and produces pain, which may be severe. Herniated or ruptured discs can occur in any part of the spine. But it is more common in the lower back (lumbar spine) and neck (cervical spine).

Causes of Herniated disc

Specific individuals or people may be more at risk of disc problems and may suffer a herniated disc in many places in the spine. The causes are below;

Excessive strain or injury
Disc material degenerates with age
Weakness of ligaments that hold the disc
Strain or twisting movements
Overweight or excess weight
Repetitive motions
Smoking
Lifting heavy objects

Symptoms of Herniated disc

Symptoms and signs of a herniated disc can vary depending upon the ruptured disc’s size, location, and position.

If the disc is not pressing the nerve, the patient feels lower backache and no pain.
If the disc is pressing the nerve, then the patient feels;

Pain
Weakness
Numbness in the area of the body where the nerve travels.

1. Lumbar spine

Sciatica results from the herniated or ruptured disc in the lower back. Pressure on the several nerves of the sciatica nerve show;

Pain
Burning
Tingling
Numbness that emits from the buttocks into the legs
Primarily, one side is affected
Pain is sharp like electric-shock
Pain increases while standing, walking, or sitting
Straightening of the leg also makes the pain worse in the affected area

2. Cervical spine

Nerve compression in the neck causes sharp pain in between the shoulders. The pain moves down in the arm towards the fingers, and numbness and tingling occur in the shoulder or arm—the pain increases in certain positions.

When to see the doctor

Herniated disc didn’t require any surgery. It improves with time, ranging from a few days to a few weeks. General guidelines are;

Limit your activities. But complete bed rest is not recommended.
Take an anti-inflammatory such as ibuprofen.
First aid such as physiotherapy is best to recover fastly without surgery.
MRI is not recommended before the symptoms stay for six weeks.
Refer to a spine specialist such as a neurosurgeon if the symptoms remain for more than four weeks.
If the symptoms are;
Leg or arm weakness
Loss of feeling
No control of urine
Have a history of metastatic cancer
Recent infection
Fever
Radiculopathy that causes pain, then urgent evaluation and

imaging is needed or recommended.

Risk factors

The following factors increase the risk of a herniated disc;

Weight: Excess body weight increases the stress or pressure on the lower back herniated disc.
Occupation: physically demanding jobs such as repetitive pulling, pushing, lifting, bending, and twisting can increase the risk of a herniated disc.
Genetics: family history.
Smoking: Smoking lessens the supply of oxygen to the disc, which causes them to break more quickly.
Frequent driving: seating for an extended period with continuous vibration from the motor vehicle can stress the discs.
Being passive or inactive: being inactive or having no physical activity makes you dull and causes many health problems. Regular exercise prevents you from diseases and herniated discs.

Prevention

Following tips prevent you from the problems of back and herniated disc;

Regular exercise
Maintain good posture
Maintain a healthy weight
Quit smoking
Eat a healthy and well-balanced diet

Test and diagnosis

Tests are listed below. A common MRI and a plain x-ray of the affected area are a must to complete the evaluation of the vertebra.Note: a plain x-ray cannot be used to see the herniated disc ultimately. CT-Scan, electromyograms, and myelograms are frequently used for initial diagnosis and check.

1. X-rays

In x-rays, radiations produce a picture of the body part, showing the structure of the vertebrae and the joints. An X-ray of the spine is obtained to check the potential causes of pain, i.e., infection, tumors, fractures, etc.

2. CT-Scan

A computer tomography scan created a diagnostic image that can show the shape and size of the spinal canal and the structure around it.

3. MRI

Magnetic resonance imaging is a diagnostic test that produces a 3D image of the body structure by powerful magnetic computer technology, which can show the spinal cord, nerve roots, and area surrounding it.

4. Myelogram

An x-ray of the spinal cord by injecting the contrast material into the cerebrospinal fluid spaces can show the pressure on the spinal cord or nerves due to ruptured discs.

5. Electromyogram and Nerve conduction studies

These tests measure the electrical impulse through nerve roots, peripheral nerves, and muscle tissue. It will determine the ongoing nerve damage.

Treatment

1. Non-surgical treatment

The initial treatment of herniated disc is non-surgical and conservative. A doctor may recommend the patient to do low, painless activities for a few days to weeks. It will decrease spinal inflammation, and bed rest is not recommended.Nonsteroidal anti-inflammatory medicines treat the herniated disc if the pain is mild to moderate. An epidural steroid injection is injected into the spine under x-ray guidance to direct the medication to its exact place.Doctors may recommend physiotherapy, which includes;

Pelvic traction
Gentle massage
Ice and heat therapy
Ultrasound
Electrical muscle stimulation
Stretching exercise

Painkillers and muscle relaxants may be good with physiotherapy.

2. Surgery

If other treatments such as physiotherapy and medications do not work, doctors recommend surgery. Before surgery, the patient’s age, overall health, and other issues are taken under observation.Lage number of people relief from herniated disc after surgery, but there is no guarantee that surgery will help.If the following conditions are present in the patient, then he is considered a candidate for surgery;

Pain limits the regular activity or reduces the quality of life
Development of neurological deficiencies such as leg weakness or numbness
Feeling difficulty in walking and standing
Los of normal bladder functions
Medications and physiotherapy do not work
The patient has a good health

3. Lumbar spine surgery

Lumbar laminotomy is a procedure used to relieve the leg pain and sciatica caused by a herniated disc. In this procedure, a small incision is done in the down back area where the herniated disc is present. The incision is made in the skin, and the lamina may be removed, muscles moved to the side. Spinal infusion is performed for disc stabilization after removing the disc through discectomy.In artificial disc surgery, a small incision is made in the abdomen, and a herniated disc is removed and replaced or restored with an artificial disc.

4. Cervical spine surgery

In this procedure, a small incision is made from the front of the neck or back of the neck by the exact position of the herniated disc. A portion of the lamina is removed by laminotomy; a herniated disc is removed. After the disc is removed in anterior surgery, the spine needs stabilization.

References:

https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc
https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095
https://my.clevelandclinic.org/health/diseases/12768-herniated-disk
https://www.physio-pedia.com/Disc_Herniation