It is important to understand the anatomy of the spine, and in particular the parts involved, in order to better understand the process of a herniated disc.
Anatomy and function of the Spine
Intervertebral discs are cushions that act as shock-absorbing pads between vertebrae in your spine. Each vertebra has one disc. The annulus is a strong outer ring made of fibers, while the nucleus pulposus is a jelly-like middle.
The outermost layer of the disc, the annulus, is the strongest part of the disc. Each vertebra is connected by the annulus, which is a strong ligament. The main shock absorber is the disc’s mushy nucleus. A herniated disc is when the outer fibers of the intervertebral disc (the annulus), are damaged and the soft nucleus pulposus material bursts out of its normal place. The nucleus pulposus material may push into the spinal channel if the annulus is damaged near the spinal canal.
There are many reasons lower back problems can happen. In the past few decades, the terms ruptured disc or slipped disc have been more frequently used. Many people assume that every person with back pain is suffering from a ruptured disc. True herniated nucleus pulposus, the official medical term for this condition, is rare. A herniated disc is not the cause of most pain in the back.
Herniated Disc Causes
Although rare, herniated discs may occur in children. A true herniated nucleus pilutosus is more common in middle-aged and young adults. Degenerative changes in the spine that happen with age make it less likely that an older person will develop a true herniated disc.
Too much pressure on a disc can cause it to burst. A fall from a ladder or landing in a seated position can cause severe damage to the spine. A strong enough force can cause a vertebra to fracture, break or rupture, depending on how strong the force is. The discs between the vertebrae are subject to a lot of pressure when you bend over. A disc can rupture if you bend to lift too much weight.
discs can also burst from a slight force. This is usually caused by weakening the annulus fibers from repeated injuries over time. You may lift or bend something that puts too much pressure on the disc as the annulus begins to weaken. A weakening disc can rupture while you’re doing something that would have been impossible five years ago. This is how the spine ages.
Two things can lead to a herniated disc: The first is that the material from the nucleus pulposus has the potential to cause pressure on the spinal canal nerves. Evidence suggests that nerve roots can be chemically irritated by the nucleus pulposus substance.
The nerve root’s function can be affected by both the chemical irritation and pressure. Combining the two can lead to pain, weakness, or numbness in an area of your body where the nerve normally goes.
Herniated Disc Signs
True herniated disc symptoms may not cause back pain. A herniated disc is caused by pressure on the nerves and irritation. Many people experience back pain when their disc bursts. A herniated disc can cause symptoms such as:
- A leg or one of the legs feels pain.
- Tingling or numbness in one or both of the legs
- Muscle weakness in one or both legs
- Reflexes lost in one or both legs
The location of these symptoms depends on the affected nerve(s) in the lumbar spine. The location of your symptoms will help you determine the diagnosis. Your doctor will be able to determine if the disc is likely to have ruptured by knowing where the pain is felt.
Herniated Disc Diagnosis
A complete history and physical exam are necessary to diagnose a herniated nucleus pulposus. Your doctor will ask you the following questions:
- Have you suffered an injury?
- Where is the pain?
- Is there any numbness in your hands? Where?
- Are there any weaknesses in your personality? Where?
- Do you remember having this problem?
- Are you experiencing recent weight loss, fevers or other illnesses?
Your doctor may also be interested in determining if you experience problems with urination or bowel movements. It is crucial to check that the herniated disc is not pressing on nerves leading to the bladder and bowels. This could be a serious emergency that may require urgent surgery.
Your doctor might recommend X-rays to examine your lower back. While regular X-rays won’t show a herniated disc, they can give your doctor a better idea of the extent of wear and tear in your spine.
The MRI scan is the most commonly used test to diagnose a herniated disc. The MRI scan is painless and extremely accurate. It has no side effects, as far as we are aware. It is almost as good as X-rays, and has replaced the myelogram (and CAT scan) in the case of a suspected herniated disc.
Sometimes the MRI doesn’t tell all. Other tests might be recommended. A combination of a CAT scan and a myelogram may be required to provide as much information as possible. If the diagnosis of a herniated disc is not clear, further, more specific tests may be required. The EMG and SSP can be used to confirm that your leg pain is caused by a damaged nerve. These tests might be necessary before you decide to have surgery.
Herniated Disc Treatment
A herniated disc does not necessarily mean you need surgery. A herniated disc is unlikely to require surgery in the majority of cases. The symptoms of a herniated disc will determine the treatment. The severity of the symptoms will also determine whether they are getting worse or getting better. Your doctor might recommend surgery if the symptoms get worse. Your doctor may recommend waiting and watching to see if your symptoms improve. Many people who have initially experienced problems with a herniated disc find that their symptoms resolve within weeks or months.
Conservative Treatment
Observation
The doctor may recommend that you just watch to ensure the problem doesn’t worsen. Your doctor might recommend that you wait until the pain subsides and you are not experiencing any weakness or numbness.
Rest
You may have to stop working for a few days if the pain is severe. Also, your activity level might need to be reduced. You should feel more mobile after a few days. Start a gentle walking program, and increase your daily distance.
Pain Medications
Different approaches to pain relief can be used depending on how severe your pain is. You may be able to reduce your pain with over-the-counter pain relief medications such as Tylenol and Tylenol. Follow the instructions and don’t take more than prescribed. Your doctor may recommend stronger pain medication if these do not help with your pain. These strong pain medications can be addictive and very addictive. While non-narcotic pain medications are more addictive than narcotics, they are also less effective. Most doctors don’t like prescribing narcotics that last more than a few weeks or days.
Epidural Steroid Injection (ESI)
The ESI is reserved for severe pain caused by a herniated disc. Unless surgery is rapidly becoming an option, it is not recommended. In about half of the cases where it is used, the ESI can reduce the pain caused by a herniated disc.
Surgical Treatment
Laminotomy or Discectomy
A laminectomy or discectomy is the traditional method of treating a herniated disc. Laminotomy is a way to “make an opening in your lamina” and discectomy is a way to “remove the disc”.
The procedure involves making an incision at the back, extending across the herniated disc. After the incision has been made through the skin the muscles are moved to one side so the surgeon can view the back of the vertebrae. To ensure that the right vertebrae are chosen, X-rays may be necessary. The disc ruptured vertebrae are separated by a small opening. This allows the surgeon access to the spinal canal. Laminotomy, which means to make an opening in the spinal canal, refers to the fact that a small portion of the bone must be removed. This allows for more light to enter the spinal canal, and also gives you room to work.
After this, the surgeon will move the nerve roots out of the path to view the intervertebral disc. The surgeon will locate the disc material that has burst into the spinal canal and will remove it. The surgeon will remove any pressure or irritation that may have been placed on the nerves. He also uses small instruments that can be inserted into the disc to remove as much nucleus pulposus material as possible. This is to ensure that no disc material remains after the operation.
The back muscles are repositioned around the spine after the procedure is completed. Sutures or metal staples are used to close the incision.
Microdiscectomy
Recent improvements in the tools that a spinal surgeon has to perform a discectomy and laminotomy have resulted in some significant improvements. It is similar to traditional methods of removing a disc, but requires a smaller incision. This procedure is safer than the traditional one because it causes less damage to normal spine parts. It is possible to recover quicker.
An operating microscope is used by the surgeon to view through the small incision. An incision of as little as 2 inches is made in the back, just above the location where the disc has herniated. After the muscles have been removed and the vertebrae can be seen, the operation is completed with a microscope. The remainder of the procedure is exactly the same as the traditional one described above.
Endoscopic Discectomy
Special TV cameras have revolutionized many surgical procedures. It is the same procedure, except that a magnified TV camera with magnified lenses is inserted into the spinal canal. This allows the surgeon to see the disc material. The camera and other surgical instruments can be inserted through these tiny incisions. Instead of looking through a microscope, the surgeon watches the TV screen and directs the instruments that are specially designed to remove the disc material.
The arthroscope can now remove torn cartilages from the knee, while the laparoscope can remove gallbladders. This same approach is being used for spine surgery. Endoscopic discectomy may cause less damage due to a smaller incision. This surgical procedure is still in development and is not widely used. This procedure is more gentle on the spine than traditional surgery. This allows for a faster recovery time and less complications.
The consequences of delaying treatment
A herniated disc is a condition that causes severe pain. Most people seek treatment because they feel the pain is too much to bear and want relief. Some people will claim they are tolerant to pain and wait for it to go away. However, the pain does not necessarily mean that they have healed. Untreated herniated discs can cause more serious problems that may become chronic. To prevent the problem from getting worse, it is best to see an Atlanta chiropractor as soon as you suspect it.
Nerve impulses can be cut off if a bulging disc is severe. This could lead to permanent nerve damage. As the problem worsens, you might experience severe pains, incontinence or bowel movements irregularities, and even partial paralysis. A condition called saddle anesthesia is where the nerves become so compressed that the sensation is lost in the inner and back legs, legs, and area around the rectum.
A herniated disc can be treated using non-invasive techniques, but if left untreated, it may become a surgical condition.
Nerve Damage
Nerve damage can result from herniated discs that are not treated. Cauda Equina Syndrome is a particularly severe example. The cauda-equina refers to a group of nerve roots located at the lower part of the spinal column. They are responsible for controlling the muscles below our waist. This includes walking and bladder control. Permanent paralysis can be caused by cauda equina Syndrome, a type of nerve damage. It can also impact your ability to control your bladder and respond to sexual stimuli.
Even if you don’t experience this condition, it is possible to sustain nerve damage for a long time. You could experience permanent numbness, tingling, or both depending on the location of your herniated disc and the nerve it presses on.
