What Is a Herniated Disc?

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A herniated disc occurs when the soft, jelly-like material that makes up the center of each disc in your spine leaks out and presses on a nearby nerve root. Symptoms of a herniated disc may include neck or back pain, as well as tingling, numbness, and/or weakness of one or both arms or legs, depending on where in the spine the affected disc is located. While that could be anywhere, the most common location is the lower (lumbar) region.

Herniated Disc Symptoms

The first symptom of a herniated disc is usually back pain followed by symptoms related to pinching and irritation of a nearby spinal nerve root—what is known as radiculopathy.

The symptoms of radiculopathy include:

  • Tingling
  • Numbness
  • Weakness
  • Electrical sensations (e.g., "pins and needles" feeling or burning)

The area of the body in which radicular symptoms may be felt depends on the location of the herniated disc in the spine.

For instance, if the L5 spinal nerve root (located in the lumbar spine) is affected, a person may complain of tingling/pain/numbness in the lower back or buttocks that spreads down the lateral side of the leg into the foot—better known as sciatica.

If a spinal nerve root is being irritated or pinched in the cervical (upper) spine, symptoms may include pain in the neck or between the shoulder blades that spreads down the arm into the hand or fingers. Numbness or tingling in the shoulder or arm may also occur.

Serious (Though Rare) Complication

A herniated disc in the low back may lead to numbness in your groin area or around your anus (called saddle anesthesia), loss of bowel or bladder control, and back/leg pain and weakness. These are symptoms of a very serious condition known as cauda equina syndrome and require emergent medical attention.

Causes

To understand exactly what a herniated disc is, consider the anatomy of the neck and back.

To start, there is your spinal cord, which is part of your central nervous system and connects to your brain via your brain stem.

Your spinal cord runs down from your neck to your lower back through a hole in the center of your vertebral bones. Located between each vertebral bone is a rubbery disc that acts as a shock absorber and allows for movement, among other functions.

Each disc consists of two components—a tough outer layer (annulus fibrosus) and a jelly-like center (nucleus pulposus).

bulging disc occurs when the inner jelly-like substance presses against the outer layer of the disc. If the inner layer continues to push against the outer layer of the disc, the jelly-like substance can eventually pop out and irritate and/or press on nearby nerve roots - this is called a herniated disc. There are a few different reasons why a disc may herniate.

  • Aging: The most common reason is natural "wear and tear" on the body. As people get older, their discs begin to shrink and degenerate, making them more prone to herniation with a minor strain or twisting movement.
  • Trauma, which could include something like a car accident or simply lifting something that's too heavy
  • Genetics: Research suggests that some people are more genetically prone to disc problems than others. 

Risk Factors

There are several factors that increase a person's chances of developing a herniated disc. Some of these factors include:

  • Being a young male (ages 20 to 50)
  • Lifting heavy objects with your back muscles instead of your leg muscles
  • Being overweight or obese
  • Engaging in repetitive back-straining activities
  • Sitting for long periods of time, especially with driving, as car engine vibration can put extra pressure on your discs
  • Having a sedentary lifestyle
  • Smoking

Diagnosis

The diagnosis of a herniated disc is made through a medical history and physical examination. Imaging tests may be utilized to confirm the diagnosis and/or rule out alternative diagnoses.

Medical History and Exam

In addition to reviewing your symptoms, your doctor will perform a neurological examination in order to access muscle strength, reflexes, and sensation.

Your doctor will also perform a musculoskeletal exam to see if different movements trigger your pain.

Finally, if you are experiencing symptoms of a herniated disc in your lower back (the most common site), your doctor will likely perform a straight leg test.

Imaging Tests

After this, your doctor may first order an X-ray of the spine. However, an X-ray can only provide clues as to whether or not you have a herniated disc. The gold standard or definitive test for confirming the presence of a herniated disc is magnetic resonance imaging (MRI).

If a person cannot undergo an MRI (a patient has a pacemaker, for example) or cannot tolerate an MRI (e.g., a patient is claustrophobic), a computed tomography (CT) myelogram—where contrast material is injected into the space that contains cerebrospinal fluid—may be performed.

Treatment

Studies show that up to 90% of people with a herniated disc can be treated with non-surgical, conservative measures that focus on pain relief and rehabilitation. For persistent and/or severe symptoms, surgery may be warranted.

Non-Surgical Therapies

For a herniated disc, non-surgical therapies often include the following:

  • Modified activity: Bed rest is not generally recommended. Instead, a person is usually advised to engage in a low level of physical activity for a few days to several weeks.
  • Applying ice to the affected area several times a day for no more than 15 to 20 minutes at a time
  • Medication to reduce pain and inflammation: Usually, a nonsteroidal anti-inflammatory (NSAID) is recommended.
  • Therapies to relax the muscles in the back: Muscle relaxants and heat application may be useful.
  • Epidural injections: A steroid medication may be injected into the back within the space surrounding the affected nerve to ease pain and inflammation.
  • Physical therapy: Various back stretches and exercises can help soothe pain and stabilize the back muscles.
  • Complementary therapies: Treatments that some people use as an adjunct to their care include acupuncture, bee-venom pharmacopuncture, and spinal manipulation.

Surgical Therapies

For people who continue to experience symptoms despite trying non-surgical therapies, spine surgery may be an option. If symptoms don't improve after six weeks of non-operative treatment, studies show that patients who have surgery for disc herniations tend to do better than those who don't. An urgent surgical referral is warranted if a person is experiencing worsening neurological symptoms, saddle anesthesia, and/or bowel/bladder problems.

The most common surgical procedure used to treat a herniated disc is a microdiscectomy, which entails removing the herniated disc and any associated fragments that may be pinching the nearby nerve.

A Word From Verywell

Herniated discs are common and most likely not due to something you did, but rather a consequence of aging and your genes. If you are diagnosed with a herniated disc, remain active and follow your doctor's advice. Most people get well with conservative treatment.

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