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Herniated Disc

New York Spinal Specialists

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Patient Education

Herniated disc

. Spinal discs are the cushion-like pads located between the vertebrae. Without intervertebral discs, the bones in the spine would grind against one another.

Discs give the spine flexibility, making movements such as twisting, turning and bending possible. They also function as shock absorbers. Discs protect the spine by absorbing the impact of trauma, wear and tear, and even body weight.

Each disc has a strong outer layer and a soft, gel-like center. Thick fibers on the outside of the disc attach to adjacent vertebrae and hold the disc in place.

Herniated disc occurs when the outer layer tears or bursts open and the gel-like center leaks into the spinal canal.

Although herniated discs can occur anywhere along the spine, they generally occur in the neck or lower back.

Herniated discs are also referred to as “slipped” or ruptured discs.

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Patient Education

Herniated disc

Nerve compression from a herniated disc can cause:Pain | Numbness | Weakness

Herniated disc step-by-step

Nicks or holes in the outer layer cause the contents of the disc to spill out into the spinal canal.

There isn’t room inside the canal for anything but the spinal cord and spinal fluid. The herniated portion of the disc “invades” the space, causing compression of the nerves or spinal cord.

The gel-like substance inside the disc releases chemical irritants that cause nerve inflammation and pain.

If a herniated disc is not pressing on a nerve, mild pain may be the only symptom.

Herniated disc impinging on spinal cord/nerve roots (blue).

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Patient Education

Why do people get herniated disc?

As we age, the spinal discs begin to lose fluid volume. This is a slow process that starts around age 30. As discs dry out, microscopic cracks or tears can form on the outer surface, causing it to become brittle and weak.

A herniated disc occurs when the outer surface tears or ruptures and the gel-like center leaks into the spinal canal.

Causes of herniated disc include poor lifting habits, repetitive movements that strain the lower back, working with heavy machinery and injury such as a fall or car accident. Prolonged exposure to vibration, e.g., operating a jackhammer, can also contribute to herniated disc.

Although herniated discs can occur anywhere along the spine, they typically occur in the neck (cervical region) or lower back (lumbar region).

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Patient Education

Microtrauma

It’s normal to “blame” herniated disc on a specific activity or singular event. While this may be true in cases of traumatic injury, the root cause of most herniated discs is often something quite different.

Microtrauma refers to microscopic injury to tissue or bone. Sore muscles after a workout are an example of “good” microtrauma. Conversely, years of heavy lifting and strain are examples of “bad” microtrauma.

In the spine, disc damage occurs slowly and progressively, until one day, the cumulative effects of microtrauma cause herniated disc.

Although it may seem like herniated disc is caused by a specific injury, the more likely scenario is that it is caused by prolonged, repetitive microtrauma.

Over time, microtrauma can cause serious injury.

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Patient Education

Risk factors for herniated disc

Age; discs dry out, lose resilience

Repetitive motion, frequent heavy lifting,

wear and tear

Excessive force, e.g., falls, sports injuries

Obesity, lack of regular exercise

Smoking, poor nutrition

Does your job require you to sit/drive for long periods of time?

Prolonged sitting compresses the spine and increases risk.

Are you overweight? Carrying extra weight stresses the spine and increases risk.

Occupational and lifestyle factors can increase your risk for herniated disc.

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Patient Education

Did you know?

A compressed or inflamed spinal nerve sends signals away from the spine and out into the body. This is why symptoms such as pain, burning or numbness are felt in your arms or legs, rather than at the location of the herniated disc.

The severity of symptoms and where you feel symptoms is determined by the location of the disc and the degree of herniation.

Herniated discs occur most frequently in middle-aged adults.

+ Symptoms of herniated disc

Patient Education

Herniated disc in the lower back:

Mild to severe back pain

Muscle spasm; pain may worsen with movement

Sciatica (pain, burning/numbness that starts in the buttock and runs down the leg)

Weakness in the leg

Herniated disc in the neck:

Pain in the neck/shoulder

Numbness, tingling in the shoulder/arm

Pain that travels down the arm and into the hand or fingers

Symptoms can affect one, or both sides of the body

+ How is herniated disc diagnosed?

Magnetic Resonance Imaging (MRI):

Provides detailed images of the soft tissues in the spine

Can show the location and severity of a herniated disc

Patient Education

X-rays might be taken:

If leg pain and other symptoms persist after 2-4 weeks of conservative treatment

To rule out other conditions, e.g., tumor, infection

Electromyography (EMG):

May show nerve root compression; however, EMG cannot determine the cause of compression

+ Nonsurgical treatment for herniated disc

Patient Education

Most patients will improve after 3-6 months of conservative (nonsurgical) treatment.

Typical nonsurgical treatment regimen:RestPain/anti-inflammatory medicationCorticosteroid injections, if appropriatePhysical therapyGradual return to normal activity

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Herniated discs sometimes heal on their own through a process called resorption. This means that the disc fragments are absorbed by the body.

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Patient Education

Surgical treatment

Most patients with herniated disc will not need surgery.

Approximately 90% respond well to nonsurgical treatment. If treatment fails, or if nerve damage and weakness worsen, then surgery may be the best treatment option.

The goal of surgery is to relieve symptoms by taking pressure off the nerve/s and spinal cord.

If nonsurgical treatment doesn’t work, surgery is a

reasonable next step. The goal of surgery is to take

pressure off the spinal cord and/or nerve roots.

Decompression surgery, as it called, means that the

surgeon removes or trims the bone/tissue that is

causing the compression.

Surgery may be recommended for patients suffering from severe nerve compression, and/or leg pain and weakness.

+ Discectomy – surgical treatment for herniated disc

Patient Education

Surgical treatment involves removing the disc fragments that are pressing on the nerve.

The surgeon gains access to the herniated disc by creating an opening in the back of the affected vertebrae. This part of the procedure is called a laminotomy.

The opening makes it possible for the surgeon to remove the herniated disc fragments (discectomy) and inspect the nerve(s).

Once this has been done, the incision is closed and a dressing is applied.

Discectomy can be done as open surgery or a minimally invasive procedure.

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Patient Education

Recovery from surgery

It’s not unusual for patients to experience relief from leg pain while still in the Recovery Room, although it’s more likely that symptoms will gradually subside in the weeks following surgery.

Postoperative pain is generally mild and controlled with pain medication.

Patients are instructed to resume activity slowly. Sports, heavy lifting, and bending/twisting are discouraged until recovery is complete.

Once a disc herniates, there is a chance of it happening again. This is referred to as recurrent disc herniation. Fortunately, this only affects a small percentage of patients.

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Patient Education

Back on track!

About 90% of patients who undergo discectomy will obtain relief from their symptoms.

Expect good results from your treatment, focus on the positive, and lead a happy and productive life.