Sometimes called a slipped disc, this condition can occur anywhere along the spine. However the disc, a cushioning substance located between the bones of the spine, doesn’t actually slip; it usually ruptures or splits causing the inner gel-like substance (nucleus pulposus) to leak out and a portion of the spinal disc pushes outside its normal boundary. This is known as a herniated disc, and it is most common among people aged 30-50 because the elasticity and water content of the nucleus pulposus tend to decline after the 20s.
Problems with a herniated disc arise when the protruding disc presses on the very sensitive nerves that lie along the spine. While it’s possible to be asymptomatic with a herniated disc, most people experience one of more of the following: anything from mild to disabling pain, muscle cramping, weakness, numbness, tingling, loss of feeling and, in rare cases, loss of bowel or bladder control. Herniated discs may also cause referred pain, which means an individual may experience pain in another part of the body as a result of the spinal problem. A herniated disc in the low back, for example, can cause referred pain in the leg known as sciatica, and a herniated disc in the neck may manifest down the arm and into the hand. The amount of pain experienced with a herniated disc depends on the amount of material that ruptures and to what degree it presses on a nerve.
Radiculopathy describes a situation in which damage to the nerve root in a certain area of the spine causes the nerves not to function properly. It may be caused by a herniated disc, spinal stenosis or degenerative disc disease. Lumbar radiculopathy is also known as sciatica.
Facet joint syndrome, which may occur in the cervical or lumbar vertebrae, develops when the facet joints (which help stabilize the spine) deteriorate. The symptoms for both issues are consistent with herniated discs in general.
Because the lumbar vertebrae of the spine (in the lower back) carry most of the body’s weight, herniated discs most often occur in that region. A herniated disc in the cervical (upper or neck) region of the spine may be caused by trauma or some sort of injury, or may occur gradually with repetitive straining of the spine.
Often people who experience a herniated disc already have spinal stenosis, a condition that causes narrowing of the space around the spinal cord and spinal nerves, which leads to persistent pain and/or a lack of feeling in the buttocks and legs. This may lead to limping and decreased physical activity. A herniated disc compounds the problem as the space for the nerves is further diminished and irritation of the nerve results.
Degenerative stenosis is so common, it eventually occurs in nearly all adults as a result of the natural process of aging. However, congenital lumbar stenosis is relatively rare and usually occurs between 30 and 40 years of age.
Treatments of a herniated disc, as well as spinal stenosis, usually begin conservatively, and become more aggressive if the symptoms persist. Treatment choices depend on a number of factors including the patient’s symptoms, age and activity level, as well as the presence of worsening symptoms.
For most people, pain from a herniated disc or spinal stenosis can be controlled with medication, and non-surgical treatments are usually enough to resolve or at least manage the condition. Some of the most common non-surgical treatments include: rest and activity limitation, ice and heat applications, physical therapy, osteopathic/ chiropractic manipulations, medications and/or injections. If the pain and/or other symptoms persist or if the pain is so severe it is not feasible to try the other treatment options, surgery may be needed.
The success rate for both non-surgical and surgical treatments is very high. Continued treatment may be necessary as symptoms may be relieved for a period of time and then flare up, often unpredictably.