Spinal Disc Herniation

Cause

The intervertebral disc has an elastic ring and a soft interior. The vertical posture puts pressure on the elastic ring. Due to weakening, the soft inside can start bulging and pinch a nerve that runs nearby.
Wear of the intervertebral disc is the main cause of spinal disc herniation. This is the cause in about half of the people over fifty years. Usually, however, a spinal disc herniation causes no symptoms. The condition is part of the aging process. It’s often unclear what is causing symptoms of a herniated disc. Heavy work with a lot of lifting can cause back pain, but it doesn’t cause spinal disc herniation.

Symptoms

The main symptom is low back pain, radiating to a leg or neck pain, radiating to an arm. The pain arises in a short time, often for no apparent reason, sometimes suddenly, for example when lifting. The radiating leg pain is worse than the back pain. There is often also tingling or numbness in a part of the leg or in the foot. The pain increases with coughing and pressing. Lying down usually relieves the pain.

Diagnosis

The diagnosis of spinal disc herniation is usually already clear on the basis of the symptoms only. With specific tests of the physical examination, nerve stimulation can be determined. In order to determine which nerve is pinched, the route of the radiating pain is important. Furthermore, the doctor examines muscle strength, reflexes and skin sensation. A spinal disc herniation can be seen on an MRI scan.

Treatment

The pain diminishes when the pressure on the nerve reduces. The bulging intervertebral disc will have to shrink, which almost always happens spontaneously. In the first weeks, the back should be loaded as little as possible, but bed rest is not necessary. Painkillers help to overcome this period. In about eighty percent of people, recovery occurs in a period of two to three months.
In case of severe pain, the general practitioner may prescribe painkillers. Sometimes, the doctor may also provide opioids, which are painkillers derived from opium. These drugs are intended to eliminate the worst pain, but they don’t cure the spinal disc herniation.
Surgery is to be considered in case of permanent pain. In some specific situations, surgery is necessary in an earlier stage. In general, the worse the symptoms, the greater the chance that surgery will lead to improvement. During the operation, which is carried out under general anesthesia, the damaged disc is removed. The pinched nerve, that causes the problems, would then have adequate space. After the operation, a scar arises at the site of the removed intervertebral disc. So it’s not that the vertebrae will directly be on top of each other.

Prognosis

The course of a spinal disc herniation varies greatly. In the majority of cases, it’s a condition that heals spontaneously in a few months, without residual symptoms, or sometimes with the remaining of a numb spot or a slight loss of strength. In some cases, surgical intervention is required.
Research shows that eighty to ninety percent of the patients is satisfied with the final result after spinal disc herniation surgery. About five percent of patients operated gets a spinal disc herniation again at the same place. However, this can also be surgically treated with a good result.

Considerations

• Try to keep moving as much as possible and continue with daily activities. But avoid postures and movements that cause severe pain.
• Choose the least painful position when lying down, for example on the back with a couple of pillows under the knees or on the side with half-raised legs.
• If lying is the least painful position, the patient can take bed rest for a short period of time. But try to get out now and then. To do this, first lie on your side. Extend the legs over the edge of the bed. Then simply press yourself up sideways with both arms. When lying down again, make the same movement in reverse order.
• Lying in bed all the time for days doesn’t make sense. Due to bed rest, the muscles weaken and that will slow down recovery.

Facts

• The Latin word hernia means ‘break’.
• The prevalence of spinal disc herniation is 2%.
• Spinal disc herniation mostly occurs at the age of 25 to 50 years.
• Men are more likely to have this condition than women.
• Spinal disc herniation frequently occurs in Western countries. Posture (sitting a lot) and lack of healthy physical exercise probably play a role.