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What is a Herniated Disc?
Your spine consists of intervertebral discs sandwiched between the stack of vertebrae. Discs are round and flat, that contains inner jellylike material (nucleus pulposus) covered by outer tough layer ( annulus fibrosus). These discs act as shock absorbers, and they facilitate movement in the spine. With aging , the outer layer of the disc becomes tough & hardened , while the inner layer remains soft , with jelly like consistency . when the outer layer tears or ruptures, this jelly will leak out or slips out. This slipped out portion of the disc will compress on the surrounding nerve roots and causes pain, numbness ,& weakness . This is known as “slipped disc” or herniated disc. Slipped disc could be caused by a traumatic injury, or it may result from normal “wear and tear,” a natural process of aging called disc degeneration.
A herniated disc can occur anywhere in the spine, but it most commonly happens in the lower back( lumbar> cervical ). A herniated disc can cause discomfort, numbness, or weakness in an arm or leg, depending on where it is located.
What Causes a Herniated Disc?
Disc herniation is most commonly caused by disc degeneration, which is gradual wear and tear caused by aging. The discs grow less flexible as people age and are more prone to tearing or rupturing with even modest strain or twist.
Most patients cannot determine the reason for their ruptured disc. Lifting large weights with the back muscles rather than the leg and thigh muscles can result in a herniated disc, as can twisting and turning while lifting.
What are the Symptoms of a Herniated Disc?
Herniated discs most commonly affect the lower back, although they can also affect the neck. The signs and symptoms vary depending on the location of the disc and whether it is pushing on a nerve. Herniated discs are most commonly found on one side of the body.
- Pain in the arm or leg in addition to lower back pain
- Shooting pain in the arm or leg upon coughing or sneezing
- Numbness or tingling sensation in the parts affected by the nerve
- Weakness in the muscles served by the nerves.
How is a Disc Herniation Diagnosed?
A physical exam and a medical history are usually all that is required to diagnose a herniated disc. Your doctor may request one or more of the following tests if they suspect another condition or wants to know which nerves are impacted.
Tests of imaging
- X-rays
- CT scan
- MRI
- Myelogram
Nerve tests such as nerve conduction study and electromyography can also be indicated.
What can be the Complications of a Disc Herniation?
In rare cases, disc herniation can compress the spinal canal, including all of the cauda equina nerves. Emergency surgery may be required in such cases to avert lifelong weakening or paralysis.
How is a Herniated Disc Treated?
Conservative treatment, which consists primarily of changing activities to prevent painful movement and taking pain medication, improves symptoms in most people within a few days or weeks.
Medications
- Over the counter painkillers
- Antineuropathic medications
- Muscle relaxants
- Opioids
Surgery
Only a small percentage of persons with herniated discs require surgery. If conservative therapy fails to alleviate your symptoms, your doctor may recommend surgery, when there are any of the following red flags ( warning signs).
- Back pain after injury, such as a fall, road traffic accident
- Sudden worsening or disabling back pain
- progressive neurologic deficits like limb weakness, numbness or both
- Back pain accompanied by fever
- loss of normal bowel and bladder functions
- pain not relieved with the conservative treatments
- back pain associated with unexplained weight loss
Interventional pain management
If the pain lasts longer than six weeks, there’s a good chance it won’t go away without treatment. Because the disc will never “un-herniate” or return to normal, there is always the risk of pain reappearing at any time. Interventional pain management can help with this.
- Lumbar Epidural Steroid Injection – This procedure is a highly efficient back pain treatment. During this treatment, the doctor will insert a small needle into the epidural space and administer a little dose of medicine under fluoroscopic guidance to relieve the pain.
- Transforaminal Epidural Steroid Injection – This method is identical to the one described above, except that the drug is directed directly onto the nerve fibres that make up the nerve, delivering more medication to the affected area.
- Biacuplasty – This procedure heals damaged nerves using radiofrequency ablation (RFA) inside degenerate discs. This is an outpatient operation that takes only a few minutes.
- Spinal cord stimulation– When the inflammation in and around the afflicted nerves is too severe for an epidural injection, spinal cord stimulation (SCS) is an excellent and successful therapy option for pain relief without surgery. An electrical pulse is given directly to the spine in SCS, restricting the passage of certain neuron fibres to the brain and, as a result, the brain’s ability to experience the previously perceived pain.
- Microdiscectomy – If the inflammation in and around the afflicted nerves is too severe for an epidural injection, another alternative is microdiscectomy. Some of the injured material around the nerve(s) is removed during microdiscectomy.