A herniated or bulging disc refers to the problem with one of those rubbery cushions (discs), between your bones (vertebrae), and that stack to form your spinal column. The spinal disc comprises a soft, jellylike center (nucleus), with a hard, more rubbery outer layer (annulus). A herniated or slipped disc is also known.
A herniated or bulging disc most often occurs in the lower back. It can cause weakness, pain, numbness, or even numbness in one of the affected arms or legs depending upon where the herniated spinal disc is located. Some people may not experience symptoms from a herniated spine. Symptoms that are not severe will typically improve over time. It is rare that the problem can be treated surgically.
Signs and Symptoms of Herniated Disc
The extent and location of the herniated spinal disc will affect the signs and symptoms that the patient may experience. The herniated spine may cause low back pain or nothing at all if it is not pressing against any nerves. If it presses onto a nerve, it may cause pain or weakness. Low back pain is usually the first sign of a herniated spine.
- Lumbar spine (lower back): Sciatica/Radiculopathy frequently results from a herniated disc in the lower back. The sciatic nerve can be affected by pressure. This can cause burning and tingling sensations that radiate from the buttocks to the legs and to the feet. It’s usually only one side that is affected (left, right).
It can often be described as electric shock-like and sharp. Standing, walking, or sitting can make the pain worse. Straightening one side of the leg can worsen the pain. As well as leg pain, low back pain may be experienced. The pain in one’s legs can sometimes be more severe from acute sciatica than the pain in the low-back.
- Cervical Spine (neck): Cervical Radiculopathy (neck) is a condition that causes nerve damage in the neck. The condition can present as dull or severe pain between your shoulder blades, or in the neck. It could radiate down the arm and fingers or feel numb in the arm and shoulder. It may become worse if you move or position your body in certain ways.
Risk factors of Herniated Discs
The likelihood of a herniated or bulging disc can be increased by the following:
- Weight. Additional weight can strain the discs at your lower back.
- Occupation. Back problems are more common for those who work in physically demanding professions. The repetitive lifting, pulling and pushing of a disc can cause it to herniate.
- Genetics. Some people inherit the predisposition for a herniated disc.
- Smoking. Smoking is believed to decrease oxygen supply to discs and make them fail faster.
- Frequent driving. Regular driving can result in pressure on the spine from vibrations and prolonged sitting.
- Being sedentary. Regular exercise can prevent herniated discs.
How to get medical care and when
Most herniated discs don’t require surgery. With time, the symptoms of sciatica/radiculopathy improve in approximately 9 out of 10 people. Sometimes it takes several weeks before symptoms start to improve.
General Guidelines
- Limit your activity to 2-3 days. Walking is permissible if the patient is able to tolerate it. If the patient’s condition requires it, an anti inflammatory such as Ibuprofen might be necessary. Bedrest is not recommended.
- This is an opportunity to perform a primary care evaluation.
- The American College of Radiology will not recommend radiographic imaging like an MRI unless there has been a history of symptoms for at minimum six weeks.
- If the symptoms persist for longer than four week, it is advisable to refer the patient to a specialist in spine surgery such as a Neurosurgeon. Specialists will require advanced imaging such as an MRI before they can schedule an appointment.
You should seek immediate medical attention if you suffer from severe leg/arm weakness, loss of feeling in the genital/rectal/genital area, no control over stool or urine, history of metastatic disease, recent infection, fever, or injury. If progressive neurologic problems (such as progressive weakening) are discovered on the exam it is recommended to get imaging performed immediately.
Diagnosis & Testing
Below are the different testing options. MRI is by far the most widely used imaging method. Plain x-rays of the affected region are sometimes taken to complete the assessment. Plain radiographs are not able to show disc herniation. Before MRI, CT scans or myelograms were more often used. However, they are not as often ordered for diagnostic imaging. One very rare application of an electromyogram to diagnose is
- Xray: This is when radiation can be used to create a film, or a photograph, of a particular part of the human body. It can show the structure or outline of the vertebrae. X Rays of the spine can be taken to identify potential pain sources. tumors, infections, fractures, etc.
- Computed tomography (CT, CAT scan): This image is created after X Rays are scanned by a computer. It shows the structure and shape surrounding the spinal canal.
- Magnetic resonance imaging, (MRI) can create 3D images of the body with powerful magnets. This diagnostic test uses computer technology to show the spine, nerve root and surrounding areas.
- Myelogram (X-ray taken of spinal canal after injecting contrast material in cerebrospinal liquid space). It can reveal pressure on the spine and nerves from herniated discs, bone spurs or tumors.
- Electromyograms and Nerve Conduction studies (EMG/NCS), which measure electrical impulses along nerve roots and peripheral nervous systems, as well as muscle tissue, are two types of tests. This test will tell you if your nerves have suffered any damage in the past or are still healing. This test is not very often ordered.
Prevention
These steps will help you prevent a herniated spine:
- Exercise. Strengthening the spine and trunk muscles by strengthening them is a great idea.
- Good posture is vital. This will reduce pressure on the spine and discs. If you’re seated for a long time, make sure your back is straight. Properly lift heavy objects and allow your legs to do the majority of the lifting.
- Keep your weight under control. A high weight can increase the pressure on the spine and discs. This can lead to herniation.
- Stop smoking. Do not smoke.