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Your back, or spine, is made up of many parts. Your backbone, also called yourvertebral column, provides support and protection. It consists of 33 vertebrae (bones). The intervertebral discs are between each of the vertebra. Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit to various parts of the body. Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are strands of tissues that act as the source of power for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together, and tendons connect muscles to bones and discs. Blood vessels provide nourishment. These parts all work together to help you move about. A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body's weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.
Herniated Disc Progression
The progression to an actual herniated disc varies from slow to sudden onset of symptoms. There are 4 stages: 1. 2. 3. 4. disc protrusion prolapsed disc disc extrusion sequestered disc
Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete disc herniations. Pain resulting from a herniated disc may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (ie, tingling, numbness) and/or motor changes (ie, weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.
a loss of normal spinal curvature may be noted. The patient lies down. it is an indication the lower lumbosacral nerve roots are inflamed. loss of perianal sensation (anus). also known as Straight-leg Raising Test. Diagnosis of a Herniated Disc The spine is examined with the patient laying down and standing. but computed axial tomography (CT) or magnetic resonance imaging (MRI) provides more detail. The symptoms include bilateral leg pain. the knee is extended. Due to muscle spasm. A Lasegue test. Radiographs (x-rays) are helpful. and arms Thoracic: Pain radiates into the chest Lumbar: Pain extends into the buttocks. requiring immediate surgical intervention. The MRI is the best method and enables the physician to see the soft spinal tissues unseen in a conventional x-ray. Radiographic Evidence of HNP . If pain is aggravated or produced. paralysis of the bladder. is performed. and the hip is flexed.Progression of Herniated Disc The extremities affected are dependent upon the vertebral level at which the herniated disc occurred. legs Cauda Equina Syndrome occurs from a central disc herniation and is serious. Abnormal reflexes are noted as these changes may indicate the location of the herniation. thighs. Consider the following examples: Cervical: Pain in the neck. Radicular pain may increase when pressure is applied to the affected spinal level. Other neurological tests are performed to determine loss of sensation and/or motor function. and weakness of the anal sphincter. shoulders.
sometimes the pain from herniated discs goes away on its own after 4 to 6 weeks. Common Herniated Disc Questions What is a herniated disc? In between your vertebrae in your spine. you can try: ice during the first 24 to 48 hours after the initial injury (if you herniate your disc suddenly). The disc has a gel-like inner substance called the nucleus pulposus and a tire-like outer band called the annulus fibrosus. our intervertebral discs can lose their elasticity and water content. etc) as recommended by your doctor over-the-counter medications prescription medications physical therapy Will I need surgery? Most herniated discs respond well to non-surgical treatments. muscle spasms.The findings from the examination and tests are compared to make a proper diagnosis. making them more likely to herniate. In fact. As we grow older. This includes determining the location of the herniation so treatment options can be reviewed with the patient. swimming. What causes a herniated disc? Herniated discs can develop gradually as the result of wear and tear on the spine—a natural part of aging. Wrap the ice in a towel and put it on the painful area for 15 minutes at a time. the nucleus pulposus can start to push through the annulus fibrosus. What are some non-surgical ways to deal with a herniated disc? To help deal with pain from herniated disc. and pain. you can use a heating pad for 20 minutes at a time. heat after the first 48 hours because that will warm and relax sore tissues. They help cushion your movements. Surgery should be considered only after you've tried several months of non- . the ice will help reduce the swelling. Over several weeks or even months. you have intervertebral discs. restricting your activities that increase the pain light exercise (walking. The nucleus can push out through the annulus: That's a herniated disc. Herniated discs can also happen suddenly from incorrect lifting or twisting that aggravates a weakened disc.
eventually. herniated disc): .surgical treatment. inner core (the nucleus pulposus): If the spine becomes compressed for any reason. it may even burst – if this happens. that are stacked on top of each other. the outer layer will rupture and the inner core spurts out (a condition referred to as a complete. the pressure on one (or more) of the discs is increased. Here are some common kinds of surgery used for patients with a herniated disc: anterior cervical discectomy and fusion corpectomy laminectomy Disc Pathology . You surgeon will recommend the best kind of surgery for you. the disc will start to bulge. Intervertebral discs sit between these units of bone.Slipped Disc The human spine is made up of individual vertebrae. or units of bone. acting as shock absorbers – they are made up of a hard. outer layer (the annulus fibrosis) and a soft. If the pressure becomes too great.
because the ruptured. they mean bulging. or moves sideways – this does not happen). without returning to the centre of the disc. Slipped disc is a generic. and enlarged at the other: The discs are uniquely equipped to handle this movement – the inner core is soft. how much? If too much pressure is applied. It isn’t surprising that some patients get confused! Why does this happen? The discs that separate the vertebrae are designed to be flexible – they need to accommodate the spine when it moves in several different directions. and herniated. pain is often caused (without nerve root compression) by mechanical distension. of the outer wall. both the inner and outer layers will deform. when we bend over (either backwards or forwards) the discs are squashed at one end. causing more problems. worse still. it is important to be clear about terminology. So. At this stage. Herniated discs are usually more painful. or stretching. that the term ‘slipped’ is incorrect – this gives the impression that the entire disc slips. the disc starts to bulge. please note that the term prolapsed disc is often used by the medical profession to mean different things.The pain associated with either condition is usually severe. causing pain. In addition to this. transferring from one side to the other (and back) as the spine moves in various directions. that is. Finally. and is designed to move within the disc. If the pressure isn’t reduced (or. disc are clinical terms that accurately describe certain aspects of disc pathology. the discs are obviously designed to handle compression – the question is. When some people refer to a prolapsed disc. as a result. The outer layer of the disc is well supplied with nerves and. The terms bulging. a bulging or herniated disc will often exert pressure on the nerves that branch off the spinal column. For example. lay term that may refer to either of the two previous conditions (please note. if it’s increased) the disc will . inner core spills out into the surrounding area. however. others use the term to refer to a complete herniation (where the outer layer splits and the inner core is expelled).
How is it diagnosed? The symptoms can vary. and the organs that allow us to function normally. the patient can be physically examined to produce a very accurate diagnosis. thoracic disc. radiating chest pain is caused by a damaged. What are the consequences for back pain? As mentioned previously. the pain will be experienced in the lower back. If a minor bulge is present. numbness and pain may be felt on in the foot. To learn more about the anatomy of the spine (and the underlying causes of back pain). despite the fact that the intervertebral discs in this region are subject to less compression than discs in the thoracic spine (mid-upper back) – this is because the range of movement in the neck is far greater than in the mid-to-upper back and. in practice. For example if the S1 nerve root (which exits the spine between the S1 and S2 vertebrae) is compressed. Hence. shoulders and arms. a herniated disc can occur anywhere in the spine. The remaining hernias tend to form in the cervical spine (the neck). the symptoms can also include muscle paralysis (whether partial or complete) and organ dysfunction. the pain (and other symptoms) will often radiate into the buttocks. if the rules of both local and referred symptoms (including pain. On the other hand. if the damage occurs in the cervical spine. if a lumbar disc is affected. the pain will usually extend into the neck. where the discs are subject to the highest level of compression. possibly radiating into the buttocks. depending on the severity and location of the damage. but these are of limited value in mapping symptoms to pathology. as a result. the vast majority of all hernias (c. damage to the nerve roots from S2-S4 may affect the bladder. At a basic. in addition to producing pain in response to a harmful event (thereby alerting the brain to the problem). the nerves also control the muscles that allow us to move. a compromised disc (whether bulging or herniated) is usually very painful. The symptoms also extend into other parts of the body and can be very severe and troubling for patients. If the nerves are compressed. however. the structure weakens and. For example. the outer layer will split – either partially (in which case the inner core remains trapped) or completely. However. the pain is often localised to the back. The symptoms also include problems with motor function. in which case a hernia forms. the discs in the cervical spine are subject to far more wear-and-tear. In addition to this. as well as the back. 95%) occur in the lumbar spine (the lower back). However. anatomical level. this is caused. they are experienced in other areas of the body (into which the nerves extend). in turn. thighs and legs – a condition referred to as sciatica. by compression of the facet joints that lock the vertebrae together.continue to bulge. eventually. please visit our section on the Anatomy of Back Pain. Some practitioners prefer to use MRI and CT scans to assist their diagnosis. and partial or complete paralysis of the ankle (foot drop) may be experienced. . In theory. and muscle and organ dysfunction) are clearly understood. that is. the compression that leads to a herniated disc is caused by compression of the spine. if the spinal nerve roots are compressed (by a significant bulge or herniation) the symptoms are often local andreferred – that is. over time.
somewhat curiously.bowel. disc are usually offered a range of conservative treatments to begin with. If the condition fails to improve on its own. most people who experience a herniated disc are aged between 30 and 40 – the condition is less common in older people. and not surgically. as the intervertebral discs grow older. they become harder and less flexible as they lose water – although typically referred to as degeneration (which can lead to its own problems). this translates into additional compression of the spine. these treatments will help your symptoms for a short period of time. and less likely to distort. . or sexual organs. but it plays a slightly different role in spinal disc pathology. or herniated disc. you may be referred to a surgeon. but. lead to compression. This is because. but this should be done mechanically (using carefully applied pressure and/or distraction). it is still possible for a herniated lumbar disc to compress the sacral nerves – despite the fact that the sacral nerves exit the spinal column via holes in the sacrum. like short leg syndrome (where the difference between legs is > 5mm). At best. comprising five vertebrae: S1S5) doesn’t contain any discs. the primary risk factors that lead to compression are: Ageing Bad posture Hereditary conditions Injury Obesity For example. you may wish to visit our Spine Clinic in London. the sacral nerves are. or mobilise. we believe the correct approach is to decompress. Ageing is a risk factor in virtually all conditions. in turn. and a range of pain killing. Can it be treated? Patients with a bulging. Note: Our opinions on spinal surgery are well documented in this website – we strongly advise all of our patients not to undergo spinal surgery. or injected). for an operation called a discectomy. Note: Although the sacrum (a fused bone at the base of the lumbar spine. the spine using non invasive techniques. osteopathy or chiropractic. Instead. For example. they actually run through the lumbar spine before doing so (in a structure known as the cauda equina). or herniated. These may include physical therapy. We believe that orthopaedic medicine is the most appropriate form of treatment – the backrack™ will replicate most of the methods used by a practitioner. susceptible to a bulging or herniated disc. A hereditary condition. for more serious conditions. As a result. a bulging. may lead to biomechanical problems that. What are the risk factors? We’ve already seen that compression of the spine can lead to either a bulging. it makes the inner core harder. For example. if a patient is carrying excess weight. antiinflammatory drugs (either taken orally. or herniated disc can be successfully treated by decompressing the spine.
please visit our section on Treatment.For more details on the range of treatments available. .