Disc herniations are an extremely common spine condition that we see patients for at Virginia Spine Institute. While almost everyone has heard of a disc herniation, what we have found is that most aren’t familiar with the anatomy or really know what causes it. I’m here today to provide you with more information about your diagnosis.
The spine is made up of a series of bones and discs that alternate up and down the entire spine. At each level of disc, there is one nerve that comes off the center canal of nerves and branches off through a little space called the foramen. Each nerve travels down into the leg in a different pattern, called dermatomes. We often ask our patients, “Where does your pain go?” and that helps us identify where the initial problem may be coming from. For instance, the nerve that branches off at the L5 disc goes to the buttock, the outside of the thigh and calf, and into the top of your foot. The S1 nerve goes to the buttock, down into the back of the thigh and calf, and into the bottom or outside of the foot. While there can be overlapping symptoms, this dermatomal map helps indicate which nerve root may be pinched with a disc herniation.
A disc herniation starts with a degenerative disc or an acute injury when the outer lining of the disc tears and allows the cartilage to leak through to pinch on the nerve. Over time with aging and normal wear and tear, the discs start to degenerate. As this happens, the discs develop cracks and tears that can lead to herniations. When there is a tear in the outer lining of the disc, it allows the center cartilage in the disc to come out through the tear. It can be very painful due to the nerves fibers in the outside of the disc. Usually this pain is very severe when these acute tears occur. Even more severe is when the tear is large enough for the cartilage to pass through the lining and press directly on the nerve.
Since these nerves travel down into the legs, herniations can cause severe pain, weakness, numbness, or a combination of symptoms throughout your extremities. This can sometimes be very excruciating, and our patients often describe it as the worst pain they have ever had. If the nerve is severely pinched, it can make it difficult to walk, especially if weakness or numbness occurs. Thankfully, when the tears in the disc happen, it is often just on one side and only affects one leg, but that can still be very painful.
Leg pain isn’t the only symptom, and patients also have severe back pain, are unable to stand up straight, and oftentimes need to lay flat on the floor to get any relief. It usually takes about a week to get through the pain from the torn disc, but if you have a herniation as well as the tear, that is when you will feel the radiating pain and symptoms into your leg.
We identify these problems using x-rays and MRIs and come up with a treatment plan for you. Common non-operative treatments include:
This combined approach often gets people through these herniations and allows our patients to go back to living their lives. There are a subset of patients who go on to have worsening symptoms despite these conservative treatments and do benefit from a minimally-invasive surgical intervention.
Reviewed by: Lindsay Orosz.