A herniated disc is a problem with one of the rubbery cushions called disks that sit between the bones that stack to make up your spine (backbone). These disks have a soft jellylike center and are encased in a tougher outer covering.
Herniated Disc become painful when they irritate or compress a spinal nerve root. This causes pain, weakness, or numbness in one or both legs.
Symptoms
In between the 26 bones (vertebrae) that make up your spine are disks filled with a jelly-like material. These act as cushions for the vertebrae. A herniated disc is when part of a disk pushes through the outer layer and puts pressure on spinal nerves, which can cause pain, weakness, or changes in sensation. Most herniated discs are in the lower (lumbar) back. But herniated discs can also occur in the neck (cervical) spine. Most cases of herniated discs are caused by natural wear and tear, aging, or a sudden injury.
The most common symptom of a herniated disc is pain that travels down the spine, from your lower back (lumbar) to your legs (sciatica). This can lead to muscle weakness or tingling in one or both legs. If the herniated disk is in the cervical spine, symptoms can include pain that travels to your shoulders, arms, and hands, as well as numbness or tingling in these areas. Herniated discs can also cause pain that is sharp and gets worse with movement or with twisting movements.
A herniated disc occurs when the inner jelly-like nucleus of a disc ruptures or bulges out through the outer disk ring. This can put pressure on the spinal nerves that run through the spinal canal near the affected disc. This pressure can cause pain, weakness, or numbness. The herniated disk can also irritate the nerves by releasing chemical irritants that cause inflammation and interfere with how the nerve works.
Over time, the outer layer of a disk may weaken because of normal wear and tear, causing the inside “jelly” to leak out through a crack in the spine. Sudden strain on the spine such as from lifting a heavy object can cause a herniated disc.
A medical professional can diagnose herniated discs through a physical exam and by reviewing your symptoms. The doctor will want to know where your pain is coming from and how long you’ve been having it. The doctor will probably order an imaging test to find the location of the herniated disc. These tests can include an MRI, CT myelogram, or an electromyogram (EMG).
Diagnosis
A herniated disk occurs when all or part of the soft jelly-like center of your spinal disc pushes through a weakened spot and puts pressure on nerves or the spinal cord. This can cause pain, numbness, or weakness. Herniated disks are most common in the lower back (lumbar area). But they can also happen in the neck. Most people who have herniated disks experience pain on one side of their body. The pain usually comes from the part of your back where the affected nerve is located. Sometimes the pain travels down the arm or leg.
Your doctor will ask you about your symptoms and do a physical exam. Your doctor will check your muscles for strength and feeling, as well as the bones in your spine (vertebrae). They’ll also look for changes in how you walk or move, and whether you can put weight on your feet. Your doctor may order X-rays or other pictures of your spine to see if the vertebrae are lined up correctly. They may also order a test that measures how well your nerves can send messages.
An MRI scan is the best way to diagnose herniated discs. This is a noninvasive test that provides clear, detailed images of your herniated disc and the surrounding area. It can show how much the herniated disk is pressing on your nerves and what type of damage it has caused. It can also help your doctor know which muscles need to be strengthened.
Other tests your doctor may order include a blood test, an electrocardiogram, and a bone scan. These can help rule out other problems that can cause pain, such as arthritis.
If you have a herniated disk, your doctor may prescribe pain medicine like acetaminophen and NSAIDs. They may also give you muscle relaxants to ease the spasms that increase pain. Your doctor may also recommend physical therapy. Exercise can make your back and stomach muscles stronger and help reduce pain from herniated discs. Your doctor will teach you exercises that are safe and effective for your condition.
Treatment
The bones (vertebrae) of your spinal column protect nerves that come out of your brain and travel down your spine to form your spinal cord. Disks (called intervertebral discs) separate each bone and allow the spinal cord to bend and move. If a herniated disk presses on a spinal nerve, you may feel pain, numbness, or changes in sensation. Most herniated disks are in the lower lumbar region of the spine.
Many people with herniated discs can get relief from over-the-counter pain relievers. However, if your herniated disc pain doesn’t respond to over-the-counter medication, you might need other treatments.
Physical therapy is a vital part of treatment for herniated discs. The type of physical therapy you receive depends on your symptoms. A neurologist or physical therapist might recommend exercises to help strengthen the muscles of your back and improve flexibility. This can help relieve your pain and prevent future problems.
Over-the-counter pain relievers can include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). If these don’t relieve your pain, your doctor might suggest other medications or pain-relieving injections.
Epidural steroid injections can reduce pain by reducing inflammation in the area around your herniated disc. These injections are usually given with a needle that is guided by an X-ray to the exact area of your herniated disc. Often, several injections are needed. The injected steroids can bring relief for weeks or months at a time.
If medicine and physical therapy don’t help, your doctor might suggest surgery. He or she will remove all or part of the damaged disc to stop it from pressing on a spinal nerve. Surgical procedures to treat herniated discs include laminotomy and discectomy. Laminotomy means making an opening in the spinal bone. During surgery, your surgeon will remove the bone above the vertebrae where the herniated disk is located. Then, your surgeon will move the muscles to the side and use a microscope to see the damaged vertebra. The surgeon will then remove the herniated disc from its opening in the vertebrae and finish the operation.
Once a herniated disk is removed, it is less likely to rupture in the future. But if the disk in the same location gets injured again, it can herniate at any time.
Prevention
A herniated disc can occur when the gel-like center of a spinal disk ruptures through a tear or when the outer layer of the disc stretches or breaks. When this happens, the herniated portion of the disc may press on nerves in the spine and cause pain, tingling, and weakness. A herniated disc can affect one or multiple vertebrae in the spine, depending on the location and severity. Most herniated discs occur in the lumbar (lower back) or cervical (neck) regions of the spine. A herniated disc in the thoracic (mid-back) region is much less common because there is very little space around the spinal cord.
A herniation can be the result of a sudden injury, such as falling from a ladder or a car accident. However, repeated stress on the spine over time can also weaken a disc. The most common symptom of a herniated disc is pain that travels down the arms or legs. If you experience this type of pain, along with numbness or weakness in the affected area, see your doctor immediately.
You can help prevent herniated discs by exercising regularly and maintaining a healthy weight. Exercise helps to strengthen your core muscles, which can provide stability for the spine and reduce pressure on your discs. Incorporate regular, low-impact exercises like walking, swimming, or cycling into your routine. Exercise can also help you lose excess weight, which will reduce the amount of pressure on your spine and discs.
Maintaining good posture while sitting, standing, or sleeping can also help prevent herniated discs by keeping your bones and joints correctly aligned. Make sure to sit up straight, stand with your feet flat on the floor or elevated, and sleep on a firm mattress on your back or side, rather than on your stomach.
Generally, herniated discs will heal on their own in 6-12 weeks with rest, anti-inflammatory medications, physical therapy, and steroid injections, if needed. If your symptoms don’t improve, talk to your doctor about surgical treatment options. The spine experts at Penn Medicine can diagnose and treat herniated discs, as well as other spinal conditions such as osteoarthritis and spondylolisthesis.
