HERNIATED DISC: CAUSES, SYMPTOMS & TREATMENT

Posted by Dr. Thomas Schuler

June 25, 2012

Patients who develop pain, numbness or weakness in the arm or leg are often diagnosed with an acute disc herniation. When a patient comes in for a consultation, a couple of preliminary questions typically arise; “how did this happen or what caused this?” and “is this a slipped disc, a herniated disc, a ruptured disc-what is this?”

To answer these questions, it is important to understand what a disc is: A disc is a strong ligamented structure that connects one bone to the next thereby allowing the spine to move. This strong ligamented structure is what allows us to bend forward, backward and sideways.

A disc herniation, by definition, is displacement of disc material beyond the normal confines of the disc space. The terms disc protrusion, disc bulge, disc herniation, ruptured disc, and slipped disc all imply that disc material has extended beyond the confines of the normal disc space. These lumbar ligaments (discs) function just like knee ligaments and shoulder ligaments do and can be injured in the same way. The difference is, when the disc is stressed and ruptures, a piece of the disc from the central or peripheral portion will break off this circumferential structure and extend outward. When this extends into the spinal canal where the nerves sit, a nerve can be pinched by the mass, which is now present in the spinal canal and cause severe pain in the path of the nerve being pinched. Specifically, a disc fragment that would enter the spinal canal and pinch a nerve to the arm would cause arm pain, whereas in the low back a piece of disc that breaks off and pinches a lower extremity nerve would cause leg pain. Depending upon which nerve is pinched will produce different pain patterns as the different nerves provide sensation to different portions of the extremity. Classic sciatica, which is pain down the back of the thigh and calf, is usually caused by a herniation at one of the bottom two levels of the spinal canal pinching the L5 and/or S1 nerve and producing pain in that pattern.

Another common question is, what does a herniation look like? You can see from the photos that these pieces of disc material would occupy significant room in the tiny space that is the spinal canal; thereby compressing the nerves. The consistency of a disc depends upon whether it is the outer tough annular portion or the central soft nuclear portion. All of these fragments represent a combination of annular and nuclear herniation that you can see in the photos. In lay terms many compare the consistency of a disc herniation to that of lobster. In the cervical spine (neck), herniations are extremely small because the discs themselves are small and a tiny fragment of just several millimeters could cause severe arm and/or neck pain. In the low back, typically the herniations that are symptomatic are much larger.

The good news is that when properly identified and treated most patients will improve non-operatively. For the few that the compression remains too much, minimally invasive surgical interventions are usually highly successful in eliminating the symptoms and allowing people to return to a full and active lifestyle. We have performed these operations in both the neck and the low back on professional athletes and allowed them to return to their chosen sport without limitation or restriction once the tissue is healed. Typically, we would wait two to three months prior to return to that elite level of play. For simple daily activities, we would hope that someone would return to those within a few days of the microsurgical outpatient procedure.

What were your first symptoms of a herniated disc?

The photos demonstrate catastrophic herniations with massive fragments: