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Herniated Disc
Between the bones (vertebrae) of your spinal column are discs that contain a gel-like substance that act as shock absorbers and help keep the vertebrae in place. When one of these disks ruptures, the gel-like substance can bulge out putting pressure on nearby nerves.
This condition is referred to as a herniated disc or slipped disc and can cause severe back pain and other symptoms. Initial rest and rehabilitation will resolve many herniated discs but surgery may be required in some cases.
The discs between the spinal vertebrae are composed of a tough outer casing (the annulus) with a gel-like centre (the nucleus).
A herniated disc occurs when the annulus of the disc tears and the contents of the disc are pushed out through this tear. The bulging disc material may press on a nearby nerve causing pain and affecting function.
As we age the discs become less flexible and begin to harden, making them more prone to tears. A herniated disc can be caused by a single excessive strain or injury. However, as degeneration of the discs progresses with age, some people may suffer herniated discs from more minor exertions or twists.
Factors that can increase the likelihood of a herniated disc include:
- Ageing
- Being overweight (creating more pressure on the spinal column)
- Smoking (which can contribute to the degeneration of discs)
- Incorrect lifting
- Repetitive strenuous activity.
Some people may have a herniated disc without experiencing any symptoms. Others have severe, debilitating symptoms. The most common symptoms of a herniated disc include:
- Lower back pain
- Leg pain
- Abnormal sensations such as tingling, numbness or pins and needles
- Muscle weakness.
If problems with bowel or bladder function are experienced this may be a sign of cauda equine syndrome – a rare but serious complication of a herniated disc. Immediate medical attention should be sought if this is suspected.
In order to make an accurate diagnosis the doctor will need to perform a thorough medical evaluation consisting of a medical history and a physical examination, and may recommended diagnostic tests such as MRI or CT scanning, and x-rays.
A referral to an orthopaedic specialist for further assessment and treatment may be recommended in some cases.
In the majority of cases a herniated disc can be treated non-surgically. Surgery may be recommended in severe cases that have not responded to non-surgical treatment.
Non-surgical treatment
Non-surgical treatment involves a combination of initial rest, pain-relieving medication and physiotherapy.
Rest and activity
With the initial onset of pain, bed rest is not usually recommended for more than two days. Longer periods of rest are not effective in speeding recovery and can in fact prolong the recovery time. It is best to continue gentle activity as much as possible without stretching or straining.
Medications
Medications commonly prescribed to relieve the pain associated with a herniated disc include non-steroidal anti-inflammatory medications (NSAIDs).
In some cases steroid medications may be recommended. These can be given in tablet form or as an injection directly into the affected area.
In cases of severe pain, steroid or pain relieving medication may be given as an epidural injection – where it is injected into the space around the spinal cord.
Physiotherapy
A combination of physiotherapy treatments and specific exercises will be used to maintain movement and strengthen the muscles in the back.
For some people the use of alternative treatments such as acupuncture, chiropractic and osteopathy prove effective in treating the pain caused by a herniated disc.
Surgical treatment
Surgical treatment of a herniated disc can include:
Discectomy
This surgery involves removing all or part of the damaged disc in order to relieve pressure on the spinal nerves. A discectomy can be performed as “open” surgery (open discectomy) or “minimally invasive surgery” (microdiscetomy).
Laminectomy
This surgery involves removing parts of the vertebrae, called the lamina, in order to make more room for the spinal nerves, relieving pressure on them and reducing pain.
Spinal Fusion
This surgery involves removing the disc then fusing individual vertebrae together to reduce movement. Spinal fusion stabilises the spine and relieves pressure on the spinal nerves.
If surgery is being considered, it is important to discuss with the doctor the advantages and disadvantages of the surgery as well as the risks involved.
Anderson, K. N., Anderson, L. E. & Glanze, W. D. (Eds.) (2006) Mosby’s Medical, Nursing and Allied Health Dictionary. (6th ed.) St. Louis: The C.V. Mosby Company
HealthScout (2007) Surgery only slightly better for herniated disc. In Everybody. CMPMedica (NZ) Ltd. http://www.everybody.co.nz/page-9a5abcbc-e17c-4573-9ece-9d09fc063f83.aspx
Larson, J. (2006) Herniated Disk. The Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thompson Gale.
Your Orthopaedic Connection (2007) Herniated Disk. AmericanAcademy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00334&return_link=0
Last Reviewed – 17/10/07