Herniated Discs How are the spine and its discs designed?

The vertebrae are the bony building blocks of the spine. Between each of the largest parts (bodies) of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back (thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In addition, in the mid-buttock, beneath the fifth lumbar vertebra, is the sacrum, followed by the tailbone (coccyx).

The bony spine is designed so that vertebrae ³stacked´ together can provide a movable support structure while also protecting the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a spinous process, which is a bony prominence behind the spinal cord that shields the cord¶s nerve tissue. The vertebrae also have a strong bony ³body´ in front of the spinal cord to provide a platform suitable for weight-bearing. The discs are pads that serve as ³cushions´ between the vertebral bodies that serve to minimize the impact of movement on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus). Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result. What is a herniated disc? What causes it? As described above, each disc of the spine is designed much like a jelly donut. As the disc degenerates from age or injury, the softer central portion can rupture (herniate) through the surrounding outer ring (annulus fibrosus). This abnormal rupture of the central portion of the disc is referred to as a disc herniation. The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumber vertebrae in the low back. This area is constantly absorbing the impact of bearing the weight of the upper body. This is especially important when we are standing or sitting. The lower back is also critically involved in our body¶s movements throughout the day, as we twist the torso in rotating side to side and as we hinge the back in flexion and extension while bending or lifting. A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don¶t need surgery to correct the problem. Symptoms You can have a herniated disk without knowing it ² herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem. But some herniated disks can be painful. The location of your symptoms may vary, depending on where the herniated disk is located along your spine. Most herniated disks occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine). The symptoms of a herniated disc depend on the exact level of the spine where the disc herniation occurs and whether or not nerve tissue is being irritated. A disc herniation may not cause any symptoms. However, disc herniation can cause local pain at the level of the spine affected. If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation. This can cause shooting pain in the distribution of that nerve and usually occurs on one side of the body. For example, a disc herniation at the level between the fourth and fifth lumbar vertebrae of the low

Rarely. Weakness. It may also involve part of the foot. Repetitive lifting. Seek emergency medical attention if you have: . y y When to see a doctor Seek medical attention if your neck or back pain travels down your arm or leg. If your herniated disk is in your neck. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist. Rarely. This is medically referred to as cauda equina syndrome. bending sideways and twisting also may increase your risk of a herniated disk. due to aging-related degeneration of the disks. This can result in severe pain down both lower extremities. People with physically demanding jobs have a greater risk of back problems. using your back muscles instead of your leg and thigh muscles to lift large. Emergency surgery may be required to avoid permanent weakness or paralysis. especially between 35 and 45. the pain will typically be most intense in the shoulder and arm. the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse¶s tail. Muscles served by the affected nerves tend to weaken. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves. Causes Disk herniation is most often the result of a gradual. Weight. disk herniation can compress the entire cauda equina. a traumatic event such as a fall or a blow to the back can cause a herniated disk. heavy objects can lead to a herniated disk. Just below your waist. As you age. Sometimes. Excess body weight causes extra stress on the disks in your lower back. as can twisting and turning while lifting. This may cause you to stumble. pushing. Risk factors Factors that increase your risk of a herniated disk may include: y y y Age. Most people can¶t pinpoint the exact cause of their herniated disk. This pain may shoot into your arm or leg when you cough. Sometimes this is associated with numbness and tingling in the leg. it can press on spinal nerves on both sides of the body. The most common signs and symptoms of a herniated disk are: y Arm or leg pain. sneeze or move your spine into certain positions. tingling or weakness. There can be marked weakness of the lower extremities and even incontinence of bowel and bladder. If your herniated disk is in your lower back.back can cause a shooting pain down the buttock into the back of the thigh and down the leg. or if it¶s accompanied by numbness. your spinal disks lose some of their water content. aging-related wear and tear called disk degeneration. Numbness or tingling. you¶ll typically feel the most intense pain in your buttocks. Herniated disks are most common in middle age. pulling. or impair your ability to lift or hold items. If the disc herniation is extremely large. thigh and leg below the knee. Occupation. The pain often is worsened upon standing and decreases with lying down. Complications Your spinal cord doesn¶t extend into the lower portion of your spinal canal.

Nerve pain medications. Decrease or eliminate your Tylenol use if these combination medications are prescribed. Motrin. Radio waves and a strong magnetic field are used to create images of your body¶s internal structures. Imaging studies show that the protruding or displaced portion of the disk shrinks over time. If your pain doesn¶t improve with over-the-counter medications. such as codeine or a hydrocodone-acetaminophen combination (Vicodin. A dye is injected into the spinal fluid. duloxetine (Cymbalta). he or she may order one or more of the following tests. This test can be used to confirm the location of the herniated disk and to see which nerves are affected. Many of these drugs carry a risk of gastrointestinal bleeding. others) or naproxen (Aleve. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder. y y . This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions. others). numbness or weakness may increase to the point that you can¶t perform your usual daily activities. A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it. nausea. Tests and diagnosis In most cases of herniated disk. back of legs and the area around the rectum. Lortab. Saddle anesthesia. confusion and constipation are possible side effects from these drugs. Ryzolt) and amitriptyline often help relieve nerve-damage pain. others). tramadol (Ultram. and large doses of acetaminophen may damage the liver. your doctor may prescribe narcotics. such as ibuprofen (Advil. Treatments and drugs Conservative treatment ² mainly avoiding painful positions and following a planned exercise and pain-medication regimen ² relieves symptoms in nine out of 10 people with a herniated disk. If your doctor suspects another condition or needs to see which nerves are affected. Magnetic resonance imaging (MRI). Because these drugs have a milder set of side effects than do narcotic medications. a physical exam and a medical history are all that¶s needed to make a diagnosis. such as an infection. your doctor may tell you to take an over-the-counter pain medication. and then X-rays are taken. y y Nerve tests Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. Narcotics. If your pain is mild to moderate. Bladder or bowel dysfunction.y y y Worsening symptoms. acetaminophen (Tylenol. This can help pinpoint the location of the nerve damage. Sedation. pregabalin (Lyrica). Pain. others). Medications y Over-the-counter pain medications. spinal alignment issues or a broken bone. Drugs such as gabapentin (Neurontin). This progressive loss of sensation affects the areas that would touch a saddle ² the inner thighs. tumor. Many people get better in a month or two with conservative treatment. Plain X-rays don¶t detect herniated disks. Myelogram. Imaging tests y y X-rays. for a short time. corresponding to the improvement in symptoms. Computerized tomography (CT scan). they¶re increasingly being used as first-line prescription medications for people who have herniated disks. but they may be performed to rule out other causes of back pain.

Your doctor may suggest surgery if: y y y Conservative treatment fails to improve your symptoms after six weeks A disk fragment lodges in your spinal canal. physical therapy can advance you to a rehabilitation program of core strength and stability to maximize your back health and help protect against future injury. Over-the-counter medications ² such as ibuprofen (Advil. others) ² may help reduce the pain associated with a herniated disk. y y . acetaminophen (Tylenol. Try to avoid activities that worsen your pain during the healing process. the vertebrae may need to be fused together with metal hardware to provide spinal stability. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves. Avoid too much bedrest. using spinal imaging to more safely guide the needle. Cortisone injections. A physical therapist may also recommend: y y y y y Heat or ice Traction Ultrasound Electrical stimulation Short-term bracing for the neck or lower back Surgery A very small number of people with herniated disks eventually need surgery. Muscle relaxants such as diazepam (Valium) or cyclobenzaprine (Flexeril.y y Muscle relaxers. Therapy Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk. Sedation and dizziness are common side effects of these medications. Initially. others) or naproxen (Aleve. Amrix) also may be prescribed if you have back or limb spasms. pressing on a nerve and resulting in progressive weakness You¶re having significant trouble performing basic activities such as standing or walking In many cases. rest in a position of comfort for 30 minutes. cold packs can be used to relieve pain and inflammation. Home style y Take pain relievers. In these cases. Too much bedrest can lead to stiff joints and weak muscles ² which can complicate your recovery. you may switch to gentle heat to give relief and comfort. the entire disk must be removed. After a few days. Use heat or cold. others). Rarely. however. Or your surgeon may suggest the implantation of an artificial disk. Motrin. surgeons can remove just the protruding portion of the disk. As the pain improves. and then go for a short walk or do some work. Instead.

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