A herniated disc, also known as a slipped or ruptured disc, occurs when the soft inner portion of a spinal disc pushes through a tear in the outer layer. This can cause pain, numbness, and weakness in the back, legs, and arms. It is estimated that over 80 percent of Americans suffer from low back pain. Although most of them cannot have a clear diagnosis of pain sources, it is very common that pain is caused by a herniated, torn, or ruptured disc, also interchangeably referred to as a “slipped disc” or correspondingly a “pinched nerve”. The condition results when part of one of the discs in the spine bulges out and irritates the nerves nearby. Patients report pain from a herniated disk in the back or radiating down one or both of the legs. This latter condition is known as sciatica or radiculopathy. The majority of disc herniations occur in the lumbar region of the spine, which includes five discs in the area between the rib cage and the pelvis. “Today, in cases of contained herniation, we can perform a minimally invasive procedure called an endoscopic discectomy,” says Dr. Liu, founder of Atlantic Spine Center.
Causes
This condition is commonly misunderstood and many patients don't fully understand what is causing their pain. The discs of the spine contain a spongy material called the nucleus which is encased in a set of fibrous rings called the annulus. Daily activity can create pressure on the discs that cause the nucleus to press against the annulus. "The discs act like shock absorbers," Dr. Liu explains. "They help to cushion the bones of the spine from the impacts of regular movement as well as more strenuous activity such as running and jumping."
Dr. Liu adds, "As we age, the annulus weakens and degenerates and the nucleus can begin to press against the annulus and cause it to bulge, or herniate, outward. In some cases, the nucleus can squeeze completely through the outer ring of the disc." Lumbar disc herniations are typically caused by general wear and tear and an abrupt, traumatic injury, such as the kind people experience when they lift something heavy while bending at the waist.
Symptoms
A herniated disk is a common cause of back pain, and it occurs when the soft inner portion of a spinal disc pushes through a tear in the outer layer. The most common symptom of a herniated disc is pain in the affected area, which can be dull, sharp, or burning. The pain may also radiate down the leg or arm, depending on the location of the herniated disc.
If the herniated disc is putting pressure on a nerve, it can cause numbness or tingling in the affected area. For example, a herniated disc in the lower back may cause numbness or tingling in the legs, while one in the neck may cause these symptoms in the arms.
In severe cases, a herniated disc can cause weakness in the affected area. For example, a herniated disc in the lower back may cause weakness in the legs, while one in the neck may cause weakness in the arms. Loss of bladder or bowel control is a rare but serious symptom of a herniated disc. If you experience sudden bladder or bowel dysfunction, seek medical attention right away. A herniated disc can cause the muscles in the affected area to become tight and painful.
The symptoms of herniated discs can vary tremendously, Dr. Liu says. "In some cases, a patient might feel only mild pain, in cases where only the disc itself is affected. But in cases where the disc material is pressing on nerve roots, patients can experience severe and unremitting pain in their back, buttocks, and legs. In some cases, patients report sensory changes such as tingling, numbness, and muscular weakness in their toes."
Treatment
An endoscopic discectomy is one of the minimally invasive spine surgical techniques for treating a slipped disc and is best for small disc tears, disc degeneration, and all kinds of disc herniations. Dr. Liu explains that this procedure is arthroscopic (endoscopic) and the least invasive but has been proven to have the same or better results than traditional spine surgery. The skin incision feels like a nail pinch and the recovery is fast. Candidates prior to this procedure are those that have been experiencing chronic low back pain that has lasted for more than eight weeks and has not responded to conservative treatments. A diagnostic MRI, CT scan or diagnostic tests are used to confirm disc herniation, and a nerve diagnostic test (such as an EMG) is used to show nerve root irritation.
The endoscopic discectomy utilizes a tiny camera, called an endoscope, which is passed through a small tube that has been inserted into the spine via a tiny incision less than an inch long. The patient is lightly sedated and the area to be operated on is treated with a local anesthetic. The entire procedure typically takes less than 1 hour. The benefit of endoscopic discectomy is less pain, less risk of infection or other complications, and a much shorter recovery time for the patient. In most cases, patients leave the surgery center or hospital the same day and are back to their typical activities in approximately a few days.
Dr. Liu adds that in many cases, a herniated disc in the back will resolve itself with conservative treatments including anti-inflammatories, physical therapy and exercise and sometimes with stronger pain medicine, when necessary. These are logical first steps before considering surgery. However, in cases where conservative herniated disk treatments don't provide relief and surgery is recommended, patients now have the more attractive option of the endoscopic discectomy over the old-fashioned open back operations which involved general anesthesia, a stay at the hospital, and lengthy, painful recovery and rehabilitation.
Risk Factors
Several factors can increase the risk of developing a herniated disc, including:
- Age: As we age, the discs in our spine lose some of their water content, making them less flexible and more prone to rupturing.
- Genetics: Some people may inherit a predisposition to developing herniated discs.
- Occupation: Jobs that involve heavy lifting or repetitive bending and twisting can increase the risk of developing a herniated disc.
- Obesity: Excess weight can put extra pressure on the discs in your spine.
Complications
In some cases, a herniated disc can cause complications. Nerve damage is one of the most common complications. If the herniated disc puts pressure on a nerve, it can cause numbness, tingling, or weakness in the affected area. Rarely, a herniated disc can cause bowel or bladder dysfunction, which requires immediate medical attention.
Prevention
While there's no surefire way to prevent herniated discs, there are some steps you can take to reduce your risk:
- Maintain a healthy weight: Excess weight can put extra pressure on the discs in your spine.
- Practice proper posture: Use good posture when sitting, standing, and lifting to reduce the strain on your back.
- Exercise regularly: Strengthening the muscles in your back, abdomen, and legs can help support your spine and reduce the risk of injury.
- Avoid heavy lifting: If you must lift heavy objects, use proper technique and ask for help if needed.
- Quit smoking: Smoking can reduce the oxygen supply to the discs in your spine, making them more prone to injury.
A herniated disc can be painful and uncomfortable but there are steps you can take to reduce your risk of developing one. By practicing good posture, exercising regularly, and avoiding heavy lifting, you can help keep your back healthy and strong. If you do experience symptoms of a herniated disc, seek medical attention right away to avoid complications.
For our video explaining Disc Herniations.
For our video on Endoscopic Discectomy.
