Herniated Disc

Symptoms

While disc herniation is most commonly found in the lower back, it may also occur in the cervical spine. Symptoms vary based on the location of the herniated disc and whether it compresses a spinal nerve. The condition typically affects only one side of the body.

Pain in the limbs: Herniation in the lower spine often results in pain radiating to the buttocks, thigh, calf, or foot. Cervical herniation may produce pain in the shoulder and arm, sometimes intensifying during coughing, sneezing, or movement. The discomfort is often sharp or burning.
Tingling or numbness: Affected nerves can cause radiating sensations or numbness in the areas they serve.
Muscle weakness: Nerve compression can lead to weakened muscles, potentially impairing coordination or grip strength.

In some cases, herniation is asymptomatic and only discovered through imaging performed for unrelated reasons.

Medical Evaluation

Evaluation by a neurosurgeon is recommended if spinal pain radiates to an extremity, or if it is accompanied by numbness, tingling, or muscular weakness.

Causes

Most cases of disc herniation result from age-related degeneration, a process that decreases the flexibility of intervertebral discs and makes them more vulnerable to injury. In many cases, the exact cause is unclear. Improper lifting techniques – especially using back muscles rather than the legs – can lead to herniation. Sudden twisting motions while lifting also pose a risk. Less frequently, trauma such as a fall or direct blow to the spine is responsible.

Risk Factors

Several factors increase the likelihood of developing a herniated disc:

• Excess weight: Places additional strain on spinal discs.

• Occupational hazards: Jobs involving repetitive lifting, bending, or twisting increase risk.

• Genetic predisposition: Family history may play a role.

• Tobacco use: Reduces oxygen supply to discs, promoting degeneration.

• Prolonged sitting: Especially while driving, may increase spinal pressure.

• Physical inactivity: Lack of exercise may contribute to weakened supporting musculature.

Complications

The spinal cord terminates near the waist, where a bundle of nerve roots called the cauda equina continues through the spinal canal. In rare instances, a herniated disc can compress this entire bundle, necessitating emergency surgical intervention to prevent permanent neurological damage.

When to Seek Emergency Medical Care

Emergency care is required in the following situations:

• Sudden difficulty urinating or passing stool.

• Loss of control over urination or bowel movements (urinary or fecal incontinence).

• Numbness in the inner thighs, around the genitals, or anus (known as saddle numbness).

• Severe or rapidly worsening weakness or pain in the legs that affects your ability to walk.

Prevention

To reduce the likelihood of disc herniation:

• Engage in regular physical activity: Strengthens core muscles that support the spine.

• Maintain good posture: Proper alignment decreases pressure on spinal structures.

• Use correct lifting techniques: Engage the legs rather than the back.

• Manage body weight: Reduces stress on the spine.

• Avoid smoking: Preserves disc health by maintaining adequate oxygenation.

Diagnosis

A physical examination typically includes assessment of spinal tenderness and limb mobility. Neurological testing may evaluate reflexes, muscle strength, gait, and sensory response.

While a clinical history and physical exam often suffice for diagnosis, additional testing may be performed:

Imaging Studies

• X-rays: Cannot detect herniation but help exclude other causes of pain.

• CT scan: Produces cross-sectional views of spinal structures.

• MRI: Provides detailed images to confirm herniation and assess nerve involvement.

• Myelogram: Uses contrast dye to highlight pressure on the spinal cord or nerves.

Nerve Function Tests

• Nerve conduction study: Measures electrical impulses through nerves and muscles using skin electrodes.

• Electromyogram (EMG): Involves inserting a needle into muscles to record electrical activity during rest and movement.

Treatment

Initial management is conservative and includes modifying physical activities and using medication to control symptoms. Most individuals experience improvement within several days or weeks.

Medications

• Over-the-counter analgesics: Mild to moderate pain may be managed with medications such as ibuprofen or diclofenac.

• Neuropathic agents: Medications like gabapentin, pregabalin, duloxetine, or venlafaxine help modulate nerve pain.

• Muscle relaxants: May be used for muscle spasms, though sedation and dizziness are common side effects.

• Corticosteroid injections: If oral medications are ineffective, corticosteroids may be injected near affected spinal nerves, often with imaging guidance.

• Pain management: Approaches include medications, medical procedures, and therapy, which help with chronic pain and improve the quality of life.

Physical Therapy

Rehabilitation may involve exercises and posture techniques designed to relieve pressure on the affected disc and reduce pain.

Surgery

Surgical intervention is considered when conservative treatments fail to relieve symptoms, particularly in cases involving:

• Persistent or severe pain

• Significant numbness or weakness

• Difficulty with standing or walking

• Loss of bowel or bladder control

Surgery often involves removing the herniated portion of the disc (discectomy). In uncommon situations, the entire disc may need removal, followed by spinal fusion using bone grafts and hardware. In select cases, artificial disc replacement may be recommended.