Approximately 75% of Americans will experience back pain during their lifetime, especially low back pain. Many of these symptoms are a result of a herniated, slipped or ruptured disc, which most commonly occurs in the lower lumbar spine, although it can be present in both the cervical (neck) and thoracic (middle back) region. Patient’s typically experience back pain that is described as sharp and stabbing along with leg pain (sciatica) or arm pain. Symptoms can also include numbness and weakness in the extremities. The lumbar spine or lower back accounts for the majority of all herniated discs, specifically between the vertebrae at L4/L5 and L5/S1. The spinal column is made up of bones that are stacked on top of each other. Their job is to provide support for the body and protect the spinal cord. Large nerve roots exit from the spinal cord through openings created at each level of the spinal cord. These nerves are what provide muscle strength and sensation to specific parts of the body. In between each vertebral bone lies a shock absorbing disc. The disc is composed of the inner nucleus pulposus, which is fluid filled and the outer annulus fibrosus, which is a tough covering. When a herniation or bulging disc is discussed, it is referring to the disc that lies between each vertebral body in the spine. Unfortunately, the disc herniation can push against the exiting nerves and release chemicals that irritate the nerve resulting in localized pain at the sight of the herniation and affect the muscles that the nerve travels to.
Although disc herniation may be linked to a causative event, factors influencing the development of a herniation include: gender (more common in men), obesity (the more weight you carry, the more stress of the spine), sedentary lifestyle and poor muscle tone/strength, improper lifting, repetitive activities that strain your back, tobacco use (decreased amount of oxygen reaches the disc), along with factors involved in the natural aging process. As we age the normal fluid content in the middle of the disc (nucleus pulposus) can dry out resulting in weakness.
Disc herniation may also be linked to a traumatic event or sudden injury leading to immediate symptoms of spinal pain with possible arm or leg involvement. In some cases loss of bowel or bladder function may also occur. Although this is an extremely rare condition, it is a serious problem called cauda equina syndrome where the spinal nerve roots are being compressed. This requires immediate medical attention.
To determine if a patient has a herniated disc, a complete and thorough history and physical should be performed. The physician may ask you about the length of time you have suffered from back or neck pain, what treatments you have undergone, any previous x-rays and a possible precipitating event leading to the symptoms. Likewise, a thorough physical exam, which would likely include a neurological exam, could be performed to detect muscle weakness or loss of sensation in the arms or legs. Along with a history and physical, imaging tests, that may include a MRI (Magnetic Resonance Imaging), are valuable diagnostic tools used to assess the intervertebral discs.
Although a herniation can be very painful and limit your ability to function for a period of time, most people do not require surgery for this condition since the symptoms gradually resolve with conservative treatments. These treatments can include rest, short term corset style bracing, physical therapy, anti-inflammatory medications or narcotics, pain management evaluation and possible injection therapy.
Surgical treatment could be indicated in patients who have nerve damage in the form of numbness or weakness in an extremity, cauda equina syndrome or who do not recover with non-operative treatment. The most common lumbar procedure performed involves removing the herniated section of the disc and any fragments that could be pressing against the spine or spinal nerves. It should be noted that even with the removal of a herniated disc, there remains a 20% chance of disc re-herniation with another fragment over a 2 year period.
Lumbar Herniated Disc by Jean-Jacques Abitbol, MD, FRCSC, Edgar G. Dawson, M.D and Regis W. Haid, Jr., M
Lumbar Herniated Disc by Dr. Peter Ullrich, 7/22/09