A herniated disc occurs when the tough covering of a disc in the spine tears or ruptures. The soft, jelly-like interior of the disc may then bulge out (herniate) through the covering.
Aging, injuries, and being overweight can cause a herniated disc.
When herniated discs cause pain, it can be slight to debilitating.
Imaging tests are done to make the diagnosis.
People can reduce their risk of a herniated disc by exercising, strengthening their muscles, and maintaining a healthy weight.
Treatment includes measures to relieve pain and sometimes surgery.
The spine (spinal column) consists of back bones (vertebrae). There are shock-absorbing discs between each of the vertebrae. The discs have a tough, outer layer of fibrocartilage and a soft, jelly-like interior called the nucleus pulposus.
If a disc is suddenly squeezed by the vertebrae above and below it (as when lifting a heavy object), the outer layer may tear (rupture), causing pain. The interior of the disc can squeeze through the tear in the covering, so that part of the interior bulges out (herniates). This bulge can compress, irritate, and even damage the spinal nerve root or sometimes the last portion of spinal cord at the L1-L2 level of the spine (see also Compression of the Spinal Cord). A ruptured or herniated disc in the low back commonly causes low back pain and sciatica. It can cause neck pain if the rupture or herniation affects a disc that is in the neck (called a herniated cervical disc).
The majority of herniated discs occur in the lower back. They are most common among people aged 30 to 50 years. Between these ages, the covering weakens. The jelly-like interior, which is under high pressure, may squeeze through a tear or a weakened spot in the covering and bulge out. After age 50, the interior of the disc begins to harden, making herniation less likely.
A disc may herniate because of a sudden, traumatic injury or repeated minor injuries. Being overweight or lifting heavy objects, particularly lifting incorrectly, increases the risk.
A Herniated Disc
The tough covering of a disc in the spine can tear (rupture), causing pain. The soft, jelly-like interior may then bulge out (herniate) through the covering, causing more pain. Pain occurs because the bulge puts pressure on the spinal nerve root next to it. Sometimes the nerve root becomes inflamed or is damaged. |
Symptoms of Herniated Disc
Often, herniated discs, even ones that appear obviously bulging or herniated on imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT), cause no symptoms. Herniated discs that do not cause symptoms are more common as people age. However, herniated discs may cause slight to debilitating pain. Movement often intensifies the pain, and the pain is worsened by coughing, sneezing, straining, or leaning forward.
Where the pain occurs depends on which disc is herniated and which spinal nerve root is affected. The pain may be felt along the pathway of the nerve compressed by the herniated disc. For example, a herniated disc in the low back commonly causes sciatica—pain along the sciatic nerve, down the back of the leg. A herniated disc in the neck causes neck pain that often extends down the arm, sometimes to the hand. Pain that starts in one place but travels to another, usually along the path of a nerve, is called radiating pain.
A herniated disc can also cause numbness and muscle weakness. If pressure on the nerve root is great, muscles effected by that nerve can become weak. Rarely, the disc can put pressure on the spinal cord itself, possibly causing weakness or paralysis of both legs. If the cauda equina (the bundle of nerves extending from the bottom of the cord in the lower back) is affected, control of bladder and bowels can be lost. If these serious symptoms develop, medical attention is required immediately.
Diagnosis of Herniated Disc
Imaging tests
Sometimes electrodiagnostic testing
Magnetic resonance imaging (MRI) or computed tomography (CT) are imaging tests that are done to identify the cause and determine the location of a herniated disc. Rarely, another imaging test called CT myelography is done when doctors need more detail of the spinal cord and surrounding bone than MRI or CT alone can provide or if MRI cannot be done.
Tests of the nerves and muscles (electrodiagnostic tests), such as nerve conduction studies and electromyography, may help identify the affected spinal nerve root.
Treatment of Herniated Disc
Measures to relieve pain
Sometimes surgery
Because a herniated disc shrinks over time, symptoms tend to lessen regardless of treatment. Most people with back pain—regardless of cause—recover without surgery within 6 weeks.
Measures to relieve pain
Applying cold (such as ice packs) or heat
Sleeping in a comfortable position on a medium mattress is recommended. People who sleep on their back can place a pillow under their knees. People who sleep on their side should use a pillow to support their head in a neutral position (not tilted down toward the bed or up toward the ceiling). They should place another pillow between their knees with their hips and knees bent slightly if that relieves their back pain. Prolonged bed rest and traction are not recommended.
As pain lessens, physical therapy and home exercises can improve posture and strengthen back muscles and thus reduce spinal movements that further irritate or compress the nerve root. (See also Prevention.)
Surgery
If a herniated disc is causing relentless or chronic sciatica, weakness, loss of sensation, or loss of bladder and bowel control (cauda equina syndrome), surgical removal of the bulging part of the disc (diskectomy) and sometimes part of the vertebra (lumbar laminectomy) may be necessary. A general anesthetic is usually required. Often, microsurgical techniques, with a small incision and regional spinal anesthesia (which numbs only a specific part of the body), can be used to remove the herniated portion of the disc. Hospitalization for this procedure is usually not required. After either procedure, most people can resume all of their activities in 6 weeks to 3 months. Surgery tends to result in faster recovery than treatment without surgery. However, after about a year or 2, people treated with or without surgery have about the same degree of recovery.
In 10 to 20% of people who have surgery for sciatica due to a herniated disc, another disc ruptures.
Prevention of Herniated Disc
It is not always possible to prevent a herniated disc, but there are ways to reduce the risk of developing one:
Exercising
Strengthening and stretching muscles
Maintaining a healthy weight
Maintaining good posture
Using proper lifting techniques
Regular exercise is an effective way to reduce the risk of developing a herniated disc. Aerobic exercise and specific muscle-strengthening and stretching exercises can help.
Aerobic exercise, such as swimming and walking, improves general fitness and generally strengthens muscles.
Specific exercises to strengthen and stretch the muscles in the abdomen, buttocks, and back (the core muscles) can help stabilize the spine and decrease strain on the discs that cushion the spine and the ligaments that hold it in place.
Muscle-strengthening exercises include pelvic tilts and abdominal curls. Stretching exercises include the knee-to-chest stretch. Stretching exercises can increase back pain in some people and therefore should be done carefully. As a general rule, any exercise that causes or increases back pain should be stopped. Exercises should be repeated until the muscles feel mildly but not completely fatigued. Breathing during each exercise is important. People who have back pain should consult a doctor before beginning to exercise.
Exercises to Prevent Low Back Pain
Pelvic Tilts Lie on the back with the knees bent, the heels on the floor, and the weight on the heels. Press the small of the back against the floor, contract the buttocks (raising them about half an inch [1 cm] from the floor), and contract the abdominal muscles. Hold this position for a count of 10. Repeat 20 times. | |
Abdominal Curls Lie on the back with the knees bent and feet on the floor. Place the hands across the chest. Contract the abdominal muscles, slowly raising the shoulders about 10 inches (25 cm) from the floor while keeping the head back (the chin should not touch the chest). Then release the abdominal muscles, slowly lowering the shoulders. Do 3 sets of 10. | |
Knee-to-Chest Stretch Lie flat on the back. Place both hands behind one knee and bring it to the chest. Hold for a count of 10. Slowly lower that leg and repeat with the other leg. Do this exercise 10 times. |
Exercise can also help people maintain a desirable weight because being overweight increases the stress on a disc.
Maintaining good posture when standing, sitting, and sleeping reduces stress on the back. Slouching should be avoided. Chair seats can be adjusted to a height that allows the feet to be flat on the floor, with the knees bent up slightly and the lower back flat against the back of the chair. If a chair does not support the lower back, a pillow can be used behind the lower back. Sitting with the feet on the floor rather than with the legs crossed is advised. People should avoid standing or sitting for long periods. If prolonged standing or sitting is unavoidable, changing positions frequently may reduce stress on the back.
Learning to lift correctly helps prevent back injury. The hips should be aligned with the shoulders (that is, not rotated to one side or the other). People with low back pain should avoid bending over with their legs nearly straight and reach out with their arms to pick up an object. Instead, they should bend at the hips and knees. Bending this way keeps the back straighter and brings the arms down to the object with the elbows at the side. Then, keeping the object close to the body, they lift the object by straightening their legs. This way, the legs, not the back, lift the object. Lifting an object over the head or twisting while lifting increases the risk of back injury.
