Many patients with back pain, leg pain, or weakness of the lower extremity muscles are diagnosed with a herniated disc. When a disc herniation occurs, the cushion that sits between the spinal vertebra is pushed outside its normal position. A herniated disc would not be a problem if it weren’t for the spinal nerves that are very close to the edge of these cushioning discs.
Spinal Discs
The spinal disc is a soft cushion that sits between each vertebra of the spine.
This spinal disc becomes more rigid with age. In a young individual, the disc is soft and elastic, but like other structures in the body, the disc gradually loses its elasticity and is more vulnerable to injury. In fact, even in individuals in their 20s, MRIs often show early evidence of disc deterioration
As the spinal disc becomes less elastic, it can rupture. When the disc ruptures, a portion of the spinal disc pushes outside its normal boundary–this is called a herniated disc. When a herniated disc bulges out from between the vertebrae, the spinal nerves and spinal cord can become pinched. There is normally a little extra space around the spinal cord and spinal nerves, but if enough of the herniated disc is pushed out of place, then these structures may be compressed.
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| A herniated disc is a cause of back and leg pain. Tom Merton / Getty Images |
Symptoms of a Herniated Disc
When the herniated disc ruptures and pushes out, the nerves may become pinched. A herniated disc may occur suddenly in an event such as a fall or an accident or may occur gradually with repetitive straining of the spine.
Often people who experience a herniated disc already have spinal stenosis, a problem that causes narrowing of the space around the spinal cord and spinal nerves. When a herniated disc occurs, the space for the nerves is further diminished, and irritation of the nerve results.
When the spinal cord or spinal nerves become compressed, they may not work properly, and send abnormal signals to and from the brain.
This means that abnormal signals may get passed from the compressed nerves, or signals may not get passed at all. Common symptoms of a herniated disc include:
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Electric Shock Pain
Pressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms, when the compression is in the lumbar (low back) region, the shocks go down your legs. -
Tingling & Numbness
Patients often have abnormal sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful electric shock sensations. -
Muscle Weakness
Because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness. Nerve irritation can also be tested by examining reflexes. -
Bowel or Bladder Problems
- These symptoms are important because it may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency, and you should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.
All of these symptoms are due to the irritation of the nerve from the herniated disc.
By interfering with the pathway by which signals are sent from your brain out to your extremities and back to the brain, all of these symptoms can be caused by a herniated disc pressing against the nerves.
Diagnosis of a Herniated Disc
Most often, your physician can make the diagnosis of a herniated disc by a thorough physical examination. By testing sensation, muscle strength, and reflexes, your physician can often establish the diagnosis of a herniated disc.
An MRI is commonly used to aid in making the diagnosis of a herniated disc. It is very important that patients understand that the MRI is only useful when used in conjunction with examination findings.
It is normal for an MRI of the lumbar spine to have abnormalities, especially as people age. Patients in their 20s may begin to have signs of disc wear, such as a disc bulge. This type of abnormality would be expected on MRIs of patients in their 40s and 50s. This is the reason that your physician may not be concerned with some MRI findings noted by a radiologist.
Making the diagnosis of a herniated disc, and coming up with a treatment plan depends on the symptoms experienced by the patient, the physical examination findings, and the results of imaging studies. Only once this information is put together can a reasonable treatment plan be considered.
Treatment of a Disc Problem
Treatment for a lumbar herniated disc will depend on your specific symptoms, the duration of symptoms, and the prognosis of the condition. While most people start with simple treatments first, there are some situations where spine surgery may be needed. Therefore, to determine the most appropriate treatment, it’s important to be evaluated by your doctor.
Sources:
Mathews HH and Long BH “Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation” J. Am. Acad. Ortho. Surg.