Herniated Disc: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

A herniated disc is a problem with one of the rubbery cushions, or discs, that sits in between the bones that stack to form the spine. These bones are called vertebrae.

The soft, jelly-like center of a spinal disc is called the nucleus. The nucleus is surrounded by the annulus, a tougher, rubbery outer layer. A herniated disc occurs when part of the nucleus pokes through an annular tear. A ruptured or slipped disc is another term that can be used to describe a herniated disc.

Herniated discs can occur anywhere along the spine, but they usually affect the lower back. Depending on where the herniated disc is located, an arm or limb may hurt, become numb, or become weak.

Many people who have ruptured discs experience no symptoms at all. If a person does develop symptoms, they often improve over time. Most of the time, the problem can be resolved without surgery.

Causes Of Herniated Disc

The most common cause of disc herniation is disc degeneration, which is a gradual wear and tear brought on by aging. As they age, the discs lose some of their pliability and are more prone to rupturing or ripping at even the tiniest twist or pressure.

The majority of people's ruptured discs have an unknown cause. Occasionally, lifting heavy objects with the back muscles used instead of the leg and thigh muscles might cause a herniated disc. Lifting, twisting, and turning might also result in a herniated disc. Rarely is the cause of a traumatic event such as a back knock or tumble.

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Symptoms Of Herniated Disc

Herniated discs usually occur in the lower back, though they can also develop in the neck. The symptoms are determined by the disc's placement and whether or not it is pressing on a nerve.

• Arm or leg pain: If you have a lower back herniated disc, you can feel pain in your calf, thigh, buttocks, and lower back. A part of your foot may be hurting as well.
• If you have a herniated disc in your neck, the areas that typically hurt the most are your arm and shoulder. When you cough, sneeze, or move into specific positions, this pain could radiate into your arm or leg. Pain that is scorching or sharp is a common description of pain.
• Any numbness or tingling: Patients with herniated discs frequently experience numbness or radiating tingling in the body part that the injured nerves supply.
• Weakness: The muscles supplied by the affected nerves usually degenerate. This might make it harder for you to grasp or lift objects, or it might cause you to stumble.
• There may be no symptoms associated with a herniated disc. Maybe you won't know about it until a spinal MRI shows it to you.

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Risk Factors Of Herniated Disc

The following factors could increase the likelihood of a herniated disc:

• Obese: An overweight individual puts a greater strain on their lower back discs.
• Workplace occupation: People who work in physically demanding jobs are more prone to experience back problems. Performing repetitive sideways bending, twisting, tugging, pushing, and lifting can increase the risk of a herniated disc.
• Genetics: A problem that some people are more likely to have is a herniated disc.
• Smoking: It is thought that smoking shortens the amount of oxygen discs get, which speeds up the breakdown process.
• Regular use of an automobile: Long periods of sitting combined with an automobile's engine vibrations might cause back discomfort.

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Diagnosis Of Herniated Disc

The physician will feel around your back to feel for any uncomfortable regions during the physical examination. You could be asked to lie flat and move your legs in different positions to determine where the discomfort is coming from.

Your doctor may also perform a neurological examination to look at your:

• Reflexes
• Muscular strength.
• The capacity to walk.
• The ability to feel light touches, pinpricks, or vibrations.

To diagnose a herniated disc, a physical examination and the patient's medical history are typically adequate. If your medical expert needs to identify which nerves are affected or if they suspect another condition, you may be subjected to one or more of the following tests.

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Imaging tests

• Radiography: Simple X-rays are not able to show herniated discs, but they can rule out other potential reasons for back pain. X-rays may show an infection, tumor, fractured bone, or issues with spinal alignment.
• CT scan: A CT scanner takes several X-rays at different angles. These images are used to create cross-sectional views of the spinal column and adjacent structures.
• MRI: A strong magnetic field and radio waves are used to create images of the internal organs. This test can be performed to confirm the location of the herniated disc and identify the affected nerves.
• Myelogram: Before a CT scan, a dye is injected into the spinal fluid. This examination can reveal issues such as multiple herniated discs or pressure on the spinal cord or nerves.

Nerve Examinations

• The efficiency with which electrical impulses travel through nerve tissue is measured by nerve conduction tests and electromyograms (EMGs). This may assist in identifying the precise site of nerve injury.
• Nerve conduction study: Electrodes are applied to the skin to assess electrical nerve impulses and nerve and muscle activity. 
• EMG, or electromyography: A needle electrode is inserted by a physician through the skin into different muscles to perform an EMG. The test assesses the muscles' electrical activity when contracted and when at rest.

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Treatment Of Herniated Disc

Changing activities to avoid painful movements and using painkillers are examples of conservative treatment. Most patients have symptom relief from this treatment in a few days or weeks.

Drugs

• Non-prescription analgesics: Your doctor may suggest over-the-counter pain medication if your discomfort is mild to moderate. Options include ibuprofen, naproxen sodium, or acetaminophen.
• Neuropathic medications: By influencing nerve signals, these medications lessen pain. These consist of venlafaxine, pregabalin, duloxetine, and gabapentin.
• Relaxants for muscles: If you experience muscle spasms, you may be prescribed these.
• Opioids: Because of their side effects and potential for addiction, many doctors are reluctant to prescribe opioids for disc herniation. Should other medications fail to alleviate your pain, your healthcare professional may consider short-term use of opioids. Both codeine and oxycodone plus acetaminophen (Percocet) are options. As side effects, these drugs may result in drowsiness, nausea, confusion, and constipation.
• Doses of cortisone: If taking oral drugs doesn't relieve your pain, your healthcare professional might recommend a corticosteroid injection. This drug can be administered into the area around the spinal nerves. Spinal imaging can help with needle guidance.

Therapy

Your healthcare staff may suggest physical therapy as a means of managing your discomfort. Physical therapists can demonstrate postures and workouts intended to reduce the pain of a herniated disk.

Surgery

Few people with herniated discs require surgery. If six weeks of conservative treatment doesn't alleviate your symptoms, surgery may be necessary, especially if you continue to have:

• Poorly controlled pain.
• Numbness or weakness.
• Having trouble standing or walking.
• Lack of bladder or bowel control.

Usually, only the protruding portion of the disc can be removed by surgeons. Seldom does it need to be completely removed. To fuse the vertebrae, a bone graft can be necessary in some circumstances.

Metal hardware is put into the spine to provide spinal stability during the several months that the bone fusion procedure takes. Your surgeon might, in rare circumstances, advise implanting a prosthetic disc.

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Prevention Of Herniated Disc

To help prevent a herniated disc, do the following:

• Train yourself: Strengthening the muscles in the trunk stabilizes and supports the spine.
• Maintain an upright position: As a result, the pressure on your spine and discs will decrease. Keep your back straight and balanced, especially if you spend a lot of time sitting down. When lifting heavy objects, ensure that your legs do the majority of the effort rather than your back.
• Keep your weight in check: Carrying excess weight puts strain on the spine and discs, raising the possibility of herniation.
• Give up smoking

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Complications Of Herniated Disc

The point right above your waist is where your spinal cord ends. The cauda equina is a group of long nerve roots that protrudes into the spinal canal and has the appearance of a horse's tail.

Disc herniation has the occasional ability to compress the whole spinal canal, including all of the nerves in the cauda equina. In rare cases, emergency surgery can be necessary to stop irreparable weakening or paralysis.

Seek emergency care if you have any of the following symptoms:

• Weakness: It's possible to feel so weak, numb, or in pain that it interferes with your daily tasks.
• Intestinal or bladder issues: Cauda equina syndrome can result in incontinence or difficulties urinating even when the bladder is full.
• Saddle anesthesia: The area surrounding the rectum, the backs of the legs, and the inner thighs are all impacted by this progressive loss of feeling when in touch with a saddle.

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