Herniated Disk

Understanding Herniated Disks

A herniated disk, sometimes called a slipped or ruptured disk, is a problem with the cushions (disks) between the bones (vertebrae) that make up your spine. These disks act like shock absorbers, helping your spine move and bend. The disk has a soft, jelly-like center (nucleus) surrounded by a tougher, rubbery exterior (annulus). A herniated disk happens when some of the jelly-like center pushes through a tear in the rubbery exterior. This can happen anywhere in your spine, but it's most common in the lower back.

What Causes Herniated Disks?

Often, herniated disks are a result of normal wear and tear on the spine as you get older. Your disks lose flexibility and become more prone to tears. Other causes include:

• Lifting improperly: Using your back muscles instead of your legs to lift heavy objects, or twisting awkwardly, can strain the disks.
• Being overweight: Extra weight puts extra pressure on the lower back disks.
• Genetics: Some people are more prone to herniated disks due to their genetic makeup.
• Physically demanding jobs: Jobs requiring heavy lifting or repetitive motions can increase the risk.
• Smoking: Smoking reduces oxygen to the disks, speeding up their deterioration.

How Doctors Diagnose Herniated Disks

A doctor will typically diagnose a herniated disk through a physical exam, asking about your medical history, and potentially conducting some tests. They might:

• Assess your movement: They might ask you to lie down, move your legs into different positions, and check your reflexes and muscle strength.
• Check your sensation: They might test your ability to feel light touch, pinpricks, and vibration.
• Order imaging tests: If needed, an X-ray, CT scan, MRI, or rarely a myelogram might be ordered to pinpoint the exact location of the herniated disk or to rule out other conditions.
• Conduct nerve tests: A nerve conduction study or electromyography (EMG) may be used to identify nerve damage.

Treating Herniated Disks

In most cases, herniated disks resolve on their own with time and conservative treatments. Common treatments include:

• Pain relievers: Over-the-counter pain relievers like ibuprofen, acetaminophen, or naproxen can help manage mild to moderate pain. For severe pain, a doctor might prescribe stronger pain medications, cortisone injections, or muscle relaxants. Opioids are sometimes used for a short time if other treatments don't work.
• Physical therapy: Exercises and stretches can help reduce pain and improve flexibility.
• Rest: Avoiding activities that worsen your pain can help your body heal.

When Surgery Is Necessary

Surgery is rarely needed for herniated disks. It might be considered if:

• Pain is severe and doesn't improve with other treatments.
• Nerve damage is significant.
• There's spinal instability.

Possible surgical procedures include:

• Discectomy: Removing the herniated portion of the disk. This can be done in an open or minimally invasive way.
• Spinal fusion: Fusing vertebrae together with metal hardware if spinal instability is present.
• Artificial disk replacement: Replacing the herniated disk with an artificial one.

Important Note: Many people with herniated disks experience improvement over time without needing surgery. If you're experiencing back pain, it's crucial to consult a doctor for proper diagnosis and treatment.

Common Symptoms of a Herniated Disk

A herniated disk happens when a cushion-like disc in your spine bulges or breaks. This can press on nearby nerves, causing pain and other problems.

Where you feel the pain:

• Lower Back Herniated Disk: If the herniated disk is in your lower back, you'll usually feel pain in your lower back, spreading to your buttocks, thigh, and calf. Sometimes, you might also feel pain in part of your foot. This pain is often described as sharp or burning.

• Neck Herniated Disk: A herniated disk in your neck typically causes the most pain in your shoulder and arm. This pain can shoot down into your arm or leg, especially when you cough, sneeze, or change positions. Again, the pain is often described as sharp or burning.

Other common symptoms:

• Numbness or Tingling: A herniated disk can cause a loss of feeling (numbness) or a prickling sensation (tingling) in the area where the affected nerves travel. This usually follows the same pattern as the pain.

• Weakness: The muscles connected to the affected nerves might get weaker. This can make it harder to lift things, hold items, or even walk without stumbling.

Important Note: Sometimes, a herniated disk doesn't cause any symptoms at all. You might not know you have one unless a doctor sees it on an X-ray, MRI, or other spinal imaging test.

If you have neck or back pain that extends into your arm or leg, or if you also experience numbness, tingling, or weakness, see a doctor right away. This could signal a more serious problem needing medical attention. Don't ignore these symptoms. Getting prompt medical care is important for proper diagnosis and treatment.

Back pain from a herniated disk often happens slowly over time, as the spinal discs wear down with age. This is called disk degeneration. As we get older, the discs lose their flexibility, making them more likely to tear or rupture, even with a small movement like aちょっとした twist or strain.

In many cases, people don't know exactly what caused their herniated disk. Sometimes, trying to lift something heavy using your back muscles instead of your legs can put too much stress on the discs. Similarly, twisting or turning while lifting can increase the risk of a herniated disk. While less common, a sudden, forceful event like a fall or a direct blow to the back can also cause a herniated disk.

Several things can make a herniated disk more likely. One key factor is weight. Carrying extra pounds puts extra pressure on the disks in your lower back, making them more vulnerable.

Jobs that require a lot of physical effort also increase the risk. Tasks like lifting, pulling, pushing, bending sideways, and twisting repeatedly can strain your back and lead to problems.

Sometimes, a person's genes play a role. Some people are naturally more prone to herniated disks because of their genetic makeup.

Smoking may also contribute to the risk. It's believed that smoking reduces the amount of oxygen reaching the disks, causing them to wear down faster.

Spending a lot of time sitting in a car, especially with the vibrations from the engine, can also put stress on your spine. The constant pressure on the spine over time can increase the chances of a herniated disk.

Finally, a sedentary lifestyle – meaning not getting enough exercise – can increase your risk. Regular physical activity helps strengthen the muscles that support your spine, which can help prevent herniated disks. In short, staying active and maintaining a healthy weight are important for protecting your back health.

Your spinal cord ends just above your waist. Below that, a collection of nerves called the cauda equina (meaning "horse's tail") runs through the spinal canal. This bundle of nerves carries signals between your brain and your lower body. Sometimes, a slipped disc (herniated disk) can press on the spinal canal and these nerves. If this happens, it can put pressure on the entire cauda equina. This is serious and, in rare cases, needs immediate surgery to prevent permanent problems like weakness or paralysis.

You need to seek immediate medical attention if you have any of these symptoms:

• Getting worse: If your pain, numbness, or weakness are getting progressively worse, making it hard to do everyday things. This means the symptoms are becoming more intense or spreading to new areas.

• Bladder or bowel problems: Cauda equina syndrome can cause trouble controlling your bladder or bowels. You might experience leaking urine or stool, or find it hard to urinate even when your bladder is full.

• Numbness or loss of feeling in the "saddle" area: This is called "saddle anesthesia." This loss of feeling happens gradually and affects the areas that would touch a saddle, including the inner thighs, backs of the legs, and the area around your rectum.

If you experience any of these symptoms, don't delay. Seek immediate medical care. Early diagnosis and treatment are crucial to prevent lasting damage.

Preventing a herniated disc involves several steps. One crucial step is regular exercise. Strengthening the muscles around your back and abdomen (your core) helps to support your spine better, reducing the risk of a herniated disc. This is important because a strong core acts like a natural brace for your spine.

Another key prevention step is quitting smoking. Smoking weakens the tissues that support your spine and can increase your risk of herniated discs. Avoid all tobacco products.

Edward Markle's experience highlights the serious impact a herniated disc can have. Despite medical treatments like nerve blocks, Edward's pain from two herniated discs became unbearable. He suffered constant pain that made sitting and walking impossible. He was forced to sleep on the floor for two hours each night just to find some relief. The pain significantly reduced his ability to live a normal life. "It took away almost all my ability to enjoy life," he said. "I couldn't move around, couldn't leave my home, and couldn't find any way to cope with the pain."

Understanding Herniated Disks: A Guide for Patients

Dr. Mohamad Bydon, a neurosurgeon, answers common questions about herniated disks. This information is for general knowledge and doesn't replace advice from your doctor.

Pain Management: A Crucial Part of Recovery

Back pain is a frequent problem. Many things can contribute to pain, including sleep and stress. Getting enough good-quality sleep allows your body to repair itself. Managing stress through healthy coping mechanisms is also important for managing pain.

Arthritis: A Common Cause of Back and Neck Pain

Wear and tear on the joints (arthritis) is a frequent cause of back and neck pain. This "degenerative" process is a natural part of aging. In fact, about 80% of people will experience severe back pain requiring medical attention at some point in their lives. While there's no cure for arthritis, it can be managed.

Managing Arthritis and Preventing Further Issues

Effective management of arthritis involves several strategies:

• Strengthening your core: Exercises that strengthen your core (abdominal and back muscles) help support your spine.
• Maintaining a healthy weight: Carrying extra weight puts extra stress on your back.
• Regular exercise: Staying active helps maintain strength and flexibility, reducing pain. Avoid a sedentary lifestyle.

Working with Your Medical Team

Open communication with your doctor and healthcare team is key to getting the best care. Being informed about your condition and asking questions empowers you to actively participate in your treatment.

Diagnosing a Herniated Disk

During a physical exam, your doctor will check for tenderness in your back. They might ask you to lie down and move your legs to pinpoint the source of your pain. A neurological exam assesses your reflexes, muscle strength, walking ability, and sensitivity to touch, pinpricks, and vibrations.

In many cases, a physical exam and a discussion of your medical history are enough to diagnose a herniated disk. However, if your doctor suspects a different issue or wants to see which nerves are affected, additional tests might be necessary:

• X-rays: These are useful for ruling out other causes of back pain, such as infections, tumors, spinal alignment problems, or broken bones. However, X-rays don't show herniated disks.
• CT Scan: A CT scan creates detailed cross-sectional images of your spine and surrounding structures, helping to visualize potential problems.
• MRI: Magnetic Resonance Imaging (MRI) uses powerful magnets and radio waves to create detailed images of soft tissues like the spinal cord and nerves. This is often used to confirm a herniated disk and determine which nerves are involved.

Specialized Tests for Nerve Function:

If nerve damage is suspected, specialized tests can help pinpoint the location:

• Nerve Conduction Studies: These tests measure how quickly electrical signals travel along your nerves. Electrodes are placed on the skin, and a small electrical current is passed through the nerve. This helps assess the health and function of the nerves and muscles.
• Electromyography (EMG): A needle electrode is inserted into various muscles to measure the electrical activity of the muscles when they are at rest and when they contract. This helps to evaluate any nerve damage.

By understanding these diagnostic tools, you can better work with your healthcare team to receive the best possible care for your herniated disk. Remember, always discuss any concerns or questions with your doctor.