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Chronic low back pain can be due to a herniated disc

Herniated disc is not a common problem, occurring in 1 out of 900 people. It is an abnormality related to the intervertebral discs which may be slipped, ruptured, bulging, or herniated. This generally affects the lumbar region of the spine, causing pain in the lower back area.

1 What is spinal disc herniation?

Each disc in your spine acts like cushion between two spinal bones (vertebrae). The spinal disc is made up two layers: the soft and squishy inner core referred to as the nucleus; and the tough and hard exterior protecting the nucleus outer called the annulus fibrosus. A herniated disc is a condition wherein the tough outer wall of the disc ruptures and the soft nucleus flows out, deforming the shape of the disc.

What is spinal disc herniation?
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2 What happens if the disc ruptures?

When the disc ruptures and the nucleus leaks out, the disc protrudes and presses on the spinal nerve, causing pain which may spread to the areas where the nerve functions. The pain, which may be mild to severe, depends on factors such as the amount of pressure the disc places on spinal cord, nerve, and tissues or the location of the damaged disc.

Pain may cover areas in the back leading towards the leg. Severe cases may lead to loss of coordination and bowel or bladder problems may occur.

What happens if the disc ruptures?
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3 What are the known causes of a herniated disc?

It is not always possible to determine the cause of a herniated disc, although few are known. Basically, the two main causes are stress and pressure on the spine. Listed below are some other factors that may cause a disc to herniate.

Spinal degeneration

Degeneration of the spinal disc occurs due to natural or age-related problems which weaken the outer core and may also be a result of daily wear and tear. This allows the inner layer to escape and push against the spinal cord.

Physical causes

This may occur while participating in sports, lifting heavy weight, performing exercise, indulging in some actions, or meeting an accident directly involving the back.

Genetic causes

This passes on from one generation to another. Though not necessarily, there is a possibility if you have a family history.

What are the known causes of a herniated disc?
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4 What are the symptoms of a herniated disc?

Slipped disc on the neck: You may experience pain while moving your neck which would further move towards the shoulders and leads to the arms and fingers. You may also experience numbness.

Slipped disc on the lower back: You may experience sciatica, which is described as a sharp, mild to unbearable pain in one part of the leg, hip, and buttocks and may feel weakness and numbness all over from the buttock to the sole of the foot.

The deformed disc pinches the sciatic nerve which radiates pain all over the leg. Sciatic nerve extends from the lower spine down to the legs, and all the way to the feet. Any kind of pain that is felt along the sciatic nerve is called sciatica.

What are the symptoms of a herniated disc?
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5 When do you feel pain the most?

  • After sitting or standing in the same position for a long time.
  • While driving
  • While bending
  • While climbing stairs or heights
  • While sneezing, coughing, or laughing
  • When lifting heavy things
When do you feel pain the most
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6 How is herniated disc diagnosed?

  • Your doctor may examine and test the following:
  • The doctor may ask you to sit, stand, walk, and run
  • He may ask you to bend
  • May ask you to move your neck, shoulders, wrists, and hands all sides
  • Check for numbness, muscle reflexes, muscle strength, and your posture

What are the diagnostic tests for herniated disc?

Electromyography (EMG): This is done to find the exact nerve root involved.

Myelogram: This is done to determine the location of the herniated disc.

Spine MRI: This shows where the disc is pressing the spinal cord.

How is herniated disc diagnosed?
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7 What are the medical treatments for herniated disc?

The treatment of herniated disc starts with bed rest for a short span of time with some medicines to cure pain. You are strictly prohibited from doing strenuous work. This is followed by physical therapy. Exercises are recommended which will help in reforming the disc.

Medicines to suppress pain:

  • Nonsteroidal anti-inflammatory drugs
  • Narcotics, if pain is severe
  • Muscle relaxants to relieve back spasm

What are the medical treatments for herniated disc?

Physical Therapy

This plays a crucial role in your recovery. This includes various exercises; heat, cold, and electrotherapy to help alleviate pain, decrease swelling, and increase strength.

Generally, the patient is cured by these treatments but if the patient still continues to experience discomfort, injections and surgery is recommended.

Injections

Steroid injections are given into the area of the herniated disc and these injections control pain for months. Injections given twice or thrice a year can suppress pain and swelling for one year but these also have side effects which are not good for health.

8 Surgery

METRx microdiscectomy

  • This operation involves endoscopic or microscopic techniques to treat the spine.
  • Only the portion of the herniated disc pinching the nerve root is removed.

Open laminectomy

This operation involves removing a portion of the bone around the nerve roots to give them additional space. A portion of the bony rim around the spinal cord is removed if it puts pressure on the nerve roots.

What lifestyle changes or activities can be done at home?

  • Maintain a healthy weight. Eat healthy foods rich in vitamin D and calcium which promote healthy bones.
  • Set an exercise routine that promotes back health and strength.
  • Practice good posture. Be careful when you sit for long durations. Do not bend too much and keep back strain to a minimum.
Surgery
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Stop alcohol and tobacco consumption. These damage bone health.

Most people would improve after these treatments but the pain could remain for long time. It may take months or years to be able to get back to all your old routine.

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