Herniated Disc

Definition

Herniated disc (slipped disc/disk) is a condition affecting the disc-like structure (intervertebral disc) between the vertebral bones that form the vertebral column (spine). In this condition the central jelly-like substance of the disc may protrude (herniate) beyond the surrounding supporting rings. In many cases herniated discs do not produce any symptoms and therefore often remains undiagnosed.

If present, symptoms include pain in the leg and arm, abnormal sensations, tingling, and numbness of the limbs. Repeated heavy weight lifting and bending may lead to a herniated disc. Treatment options include pain killers, exercise, physical therapy using hot or cold compression, ultrasonic ray and electrical stimulation. Surgery is considered only in very severe cases that do not respond to other treatments.

Symptoms

Usually a mild degree of herniation does not produce any symptoms. Severe degree of herniated disc may result in :

  • Low back pain
  • Weakness
  • Numbness or tingling sensation in the limbs
  • Pain in the upper and lower limbs depending upon the site of herniation. In case of intervertebral discs affected in neck region (cervical) pain occurs in the arm whereas if discs of lower back (lumber) are involved, legs and thigh even buttock may be affected. The pain is shooting in nature which aggravates with sneezing, coughing or change in posture.

Usually one side of the body is affected but in severe degree of herniation at the lower part of the spine, the nerve roots at the end of the spinal cord (cauda equina) may be compressed leading to pain on both sides of the body, loss of bowel or bladder control, sexual dysfunction, loss of -sensation on the inner thigh, back of the legs and around the rectal opening (saddle-back anesthesia).

Causes

The spine consists of a number of bones known as the vertebra. In between the bones (vertebra) there are round disc structures known as intervertebral discs. The discs act as shock absorbing cushions facilitating movement of the spine. The disc consists of two main parts central jelly-like structure known as nucleus pulposus and surrounding ring-like structure annulosus fibrosus.

The back and outer (posterolateral) portion of the outer ring is relatively thin and are therefore liable to tear. Through this tear the inner jelly-like structure may protrude beyond the ring. The spinal cord originating from the brain travels downwards through the bony vertebral column. The branches of nerves leave the spinal cord through the openings of the vertebra. Herniated discs may compress the nerves resulting in the symptoms seen with this condition.

With progressive aging the intervertebral discs lose water, become less flexible and more liable to injury with minor straining. In some cases fall from height, trauma to the vertebral column and weight lifting using the back muscles instead of leg muscles may cause herniation of disc. Most common site of herniation of disc is lower back region (lumber region).

Risk factors

  • Progressive age
  • Trauma to the back
  • Occupational heavy weight lifting, twisting, bending of the spine
  • Being overweight

Treatment

Treatment options include :

  • Drugs
    – Painkillers
    – Muscle relaxants
    – Steroid injections
  • Physical therapy
    – Heat or cold compression
    – Traction
    – Ultrasound therapy

Surgery is recommended in a person having progressive worsening of symptoms and an inability to perform daily activities.

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