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Herniated disc, also known as slipped disc, is a condition in which the “cushion” (intervertebral disc) between vertebrae bulges or protrudes. It commonly occurs in the lower back (lumbar spine), causing low back pain and numbness in the legs. Treatments for herniated disc and low back pain are usually conservative and nonsurgical.
A human spinal column consists of 24 movable vertebrae stacked onto each other. In between each of the vertebrae, they are cushioned by intervertebral discs acting as shock absorbers and prevent the vertebrae from grinding together. These rubbery discs are made of a soft center (nucleus pulposus) surrounded by a tough outer layer (annulus fibrosis). These intervertebral discs dehydrate and compress with age, causing them to bulge into the spinal canal. When the outer layers of the bulging annulus remain intact, it is called a bulging disc.
Herniated disc is also known as prolapsed intervertebral disc, slipped disc or ruptured disc. It happens when the disc nucleus ruptures out of the annulus through a tear or crack in the annulus. Since the spinal canal has limited space, the herniated disc can irritate and put pressure on the spinal cord and nearby spinal nerves, causing severe pain and discomfort.
A herniated disc can occur in any part of the vertebral column, but it is more common in the lumbar spine (lower back) and cervical spine (neck). Thus, herniated disc is one of the most common causes of neuralgia (nerve pain) such as low back pain, cervical spondylosis and sciatica.
In children and young adults, the intervertebral discs contain high water content that makes the spine flexible to allow for motion but resist compression. Over time, the discs begin to dry out and become less flexible and more brittle. This process is called disc degeneration, which is a natural process of aging. The discs would then be more vulnerable to tearing or rupturing by body movements, for example twisting when lifting heavy objects. Sometimes, a traumatic injury, such as a fall, can also put pressure on the discs to cause herniation, too.
Although a herniated disc is most often age-related, the following factors may also play a role in inducing a higher risk of intervertebral disc herniation:
Symptoms of herniated disc vary from person to person, greatly depending on where the disc herniated and which spinal nerve roots are affected. Sometimes, a herniated disc can be asymptomatic. In general, common signs and symptoms of herniated disc include:
Occasionally, a herniated disc can cause damage to the spinal nerves when they are severely compressed. This complication is known as cauda equina syndrome.
Cauda equina is the sack of nerves located at the end of the spinal cord. These nerve roots are responsible for motor and sensory function to the legs and the bladder. A herniated disc at the lumbar region can possibly compress these nerve roots, impairing their corresponding functions. If the situation is being untreated, cauda equina would be significantly damaged and lead to long-term problems, such as permanent paralysis, nerve pain, impaired bladder control, impaired bowel control, sexual dysfunction, etc.
Cauda equina syndrome is often related to a symptom called saddle anesthesia. It refers to the altered sensation in the areas in contact with a saddle (e.g. anus, buttocks, the inner thighs, back of the legs). If you experience symptoms such as saddle anesthesia, bladder or bowel incontinence and weakness or paralysis in the lower extremities, you should seek medical attention right away as it would require emergent surgery.
Herniated discs at different parts of the vertebral column require slightly different diagnostic methods. In general, diagnosis of a herniated disc can be made by physical examination together with imaging procedures. To confirm the diagnosis of herniated disc, the following measures are usually taken:
For the majority of patients with a herniated disc, the condition requires long-term non-invasive treatments and rehabilitation. During rehabilitation, conservative treatments are usually applied to monitor the condition, while surgery would only be applied in severe cases with complications.
First-line treatments for herniated discs usually aim to relieve pain by medications and physical therapy, for example:
Surgery may be recommended to treat herniated disc if the above-mentioned treatments fail to relieve symptoms effectively or the following conditions and complications are developed:
Surgical operations mainly focus on removing the protruding portion of the herniated disc without damaging other parts of the spinal column. These surgical procedures often include:
In addition to conservative treatments, you can also try the following tips at home to relieve symptoms caused by a herniated disc:
Disc herniation can be prevented by paying attention to your daily activities, you can reduce the risk of disc herniation by:
Yes, a herniated disc generally recovers on its own in a few months. During recovery, conservative treatments are recommended to help relieve pain and strengthen your muscles. If these approaches are not effective or If your symptoms don’t get better, you may need surgery.
A herniated disc, which is not serious, is a common spine disease that causes back pain. Nevertheless, in rare cases, a herniated disc can cause damage to the nerves when they are severely compressed. If you experience changes in bladder or bowel function, you should seek medical attention right away.
A herniated disc generally recovers on its own in a few months, non-surgical treatments are the first-line approach to treat a herniated disc. To relieve pain, nonsteroidal anti-inflammatory drugs (NSAIDs) and hot and cold therapy are helpful. In addition, physical therapy can help relieve pain and strengthen your muscles.
This article was medically reviewed by Dr. Eric Sze Tsun Yeung. Dr. Yeung is a specialist in Orthopaedics and Traumatology both in UK and HK who graduated from the University College London Medical School, University of London. Before his return to HK in 2011, Dr. Yeung was an Orthopaedic Consultant in a London teaching hospital. Dr. Yeung worked for the HK Hospital Authority at the Prince of Wales Hospital, Yan Chai Hospital and Queen Elizabeth Hospital. He is now the Honorary Clinical Associate Professor of the Department of Orthopaedics and Traumatology at both the University of Hong Kong and the Chinese University of Hong Kong. Dr. Yeung is actively practicing at the SINCERUS Orthopaedics & Rehabilitation Centre, Central, HK.
This article was independently written by Healthy Matters. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.
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