What is Herniated Disc?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

A herniated disc is a condition in which the outer shell of a cushion between the vertebrae in the spine breaks and allows soft tissue to leak out. The rupture of the disc itself causes no symptoms. However, when the disc tissue presses against spinal nerves, moderate to severe pain is likely.

The spine is made up of a column of bones called vertebrae that protect the spinal cord. Between these bones are cushions that allow flexibility and absorb shock. These cushions are called discs. Discs are made up of a tough outer exterior with a soft jelly-like center. As people age, discs lose moisture and the outer layer becomes brittle. When the brittle outer layer cracks or breaks, the center gel leaks onto surrounding nerves and tissue.

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More About Herniated Disc

lumbar foraminotomy

While any disc can herniate, or rupture, the most common areas for this to occur are the cervical discs (around the neck) or the lumbar discs (lower back). If the disc herniation does not put pressure on a nerve, there might be little or no symptoms. A herniated cervical disc may cause moderate to severe neck pain and other symptoms related to the arms. A herniated lumbar disc can cause pain in the lower back and symptoms concerning the legs.

Herniated disc pain may seem sudden, but the condition is usually the result of compiled pressure over time. Herniated discs are often considered a “wear-and-tear” problem as overuse and repetitive movements are the most common contributing factors. Genetics and, less commonly, injuries due to an accident may cause a herniated disc.

The treatments for herniated discs vary. However, in most cases, the condition is resolved with non-invasive measures. A herniated disc may heal entirely on its own over a period of months in a process called reabsorption. There are many treatments to resolve the related pain while the disc heals.

What are the symptoms?

The symptoms of a herniated disc vary from mild to severe, or even emergent. The location of the disc is a big factor in the type of symptoms that occur.

  • Moderate to severe pain: Pain might occur suddenly after strenuous work, or upon getting out of bed in the morning. The pain might worsen over time. It is common for pain to lessen or disappear completely when laying down. This removes pressure from the spinal nerves.
  • Tingling or numbness: Nerves leave the spine to spread to all areas of the body. When these nerves are compressed, numbness, pain, or tingling can occur. A cervical disc herniation commonly causes radiating pain from the shoulder down the arm. Numbness may also occur in the arm or hand. A lumbar disc herniation can cause similar symptoms in the legs. Pain and numbness may occur in the hip, thigh, calf, or foot.
  • Sciatica: This condition refers to a compressed sciatic nerve. Sciatic nerves are the major nerves that run from the spine down each leg. When a lumbar herniation compresses one of these nerves, symptoms are typically worse in the legs than in the back.
  • Pain displacement: Since nerves travel throughout the body, sometimes little or no pain is felt in the spinal area where the herniation actually occurred. Symptoms occur in the arms or legs instead.
  • Loss of bowel or bladder control: It is possible for a disc herniation to damage nerves leading to the bladder or bowels. This condition is a medical emergency and a physician should be notified immediately.

How is a Herniated Disc Diagnosed?

A herniated disc may be suspected by a regular physician, but the patient will usually be referred to a spinal surgeon for a diagnosis. There may be one or more tests needed to make a complete diagnosis.

•  Physical Examination:

A physician will determine medical history and a detailed account of occurring symptoms. Patients can expect to answer a detailed questionnaire and mark locations of each symptom on a diagram. The physician will likely complete a neurological exam. Locations on the arms or legs may be tested for numbness. Coordination and weakness are tested by standing on tip-toes, heels, or one foot at a time.

•  Symptom Assessment:

The doctor needs to know as much as possible about the symptoms the patient is experiencing. This involves answering a series of questions to give a sense of whether pain is dull or sharp, as well as where and when it’s likely to occur.

•  X-ray:

While an X-ray doesn’t actually allow a disc herniation to be seen, it is a common tool used to rule out other conditions. An X-ray might also show clues in the vertebrae that might signal a herniated disc.

•  Magnetic Resonance Imaging (MRI):

MRI allows physicians to see the spinal cord, surrounding soft tissue, and affected nerves. This is the best technology for locating and diagnosing a herniated disc.

•  Computerized Tomography (CT) Scan:

Instead of an MRI. This test may be done with or without radiographic (contrast) dye.

•  Electromyography (EMG) and Nerve Conduction Studies (NCS):

These tests use electrodes to test nerve damage and muscle weakness.

Diagnosis of a herniated disc does not come directly from the imaging test results. The combination of symptoms and other tests are important features of a complete diagnosis.

What are the Causes of a Herniated Disc?

low back pain

Discs wear out naturally with age. Starting around age 30, discs begin losing moisture. As they dry out and become brittle, tiny cracks and tears form on the outer surface. Different factors may cause these more brittle discs to rupture.

  • Strenuous work – Consistent lifting or bending can cause disc herniation.
  • Lifting the wrong way – Bending the back instead of the knees to lift is dangerous and causes back damage.
  • Repetitive movements – Certain sports or work activities that put stress on the spine are common causes of disc herniation.
  • Obesity – Extra weight puts excess pressure on discs.
  • Inactivity – Core muscles are critical in supporting the spine. Prolonged inactivity can make patients more susceptible to disc herniation during regular activities.
  • Genetics – There are some genetic factors that make disc degeneration more likely to occur.
  • Injury – It is possible to rupture a disc during a car accident or other high impact injury.

These are the most common causes of disc herniation. However, it is possible to have a herniated disc from other reasons. Symptoms are the best indication of the condition.

How are Herniated Disc treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of a Herniated Disc

Equipment used to diagnose disc herniation is usually related to imaging tests. The most common imaging tests used are X-ray and MRI.

The equipment used to treat herniated discs vary widely depending on the location of the disc and the severity of symptoms. Common equipment for treatment ranges from medication to surgical equipment.

  • Back brace: A brace may be used to alleviate pain and pressure on the back.
  • X-ray equipment: Used in the diagnosis and also used during epidural injections, X-ray equipment is critical in determining placement for precise treatment.
  • Surgical equipment: Equipment used during surgery may include small cameras and tools used to make smaller incisions for less invasive surgery and quicker healing time.
  • Surgical laser: if the herniation is limited to the soft tissue of the disc, your North American Spine physician may use a surgical laser to remove it.

How Does Herniated Disc Compare to Other Spine Conditions?

A herniated disc is similar to some other conditions that cause back pain. In fact, many conditions that create compression on spinal nerves may be mistaken for a herniated disc.

  • Collapsed Disc
  • Bulging Disc
  • Herniated Nucleus Pulposus (HNP)
  • Slipped Disc
  • Disc Extrusion
  • Disc Protrusion
  • Pinched Nerve
  • Compressed Nerve

A herniated disc can also cause certain conditions to arise. These conditions can also be caused by other spinal injuries or degeneration.

  • Sciatica – Sciatica occurs when the main nerve extending down the leg becomes compressed. It is sometimes listed as a complete diagnosis but usually has a root cause.
  • Cauda Equina Syndrome – This condition occurs when a bundle of nerves at the base of the spine becomes compressed. These nerves control bowel and bladder function. Symptoms include bladder and bowel incontinence. This is a medical emergency and should be treated immediately.
  • Spinal compression – A cervical herniated disc may cause spinal compression, where the disc material presses against the spinal cord. Symptoms include awkward or stumbling gait, difficulty with fine motor skills in hands, and shock-like feelings going down the torso or legs. This is a more serious condition that might require aggressive treatment.

Herniated disc symptoms, causes, and treatments vary widely. Without proper diagnosis and care, herniated disc symptoms may become worse over time. It is important to follow a doctor’s instructions during recovery, therapy, and after surgery to allow a return to full spinal health.

 

Analogy: Blow-Out vs Flat Tire

A bulging disc is like a flat tire, a slipped disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a bulging disc (flat tire) can progress to become a slipped disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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