Each of our 23 intervertebral discs has a nucleus (nucleus pulposus), which acts like a kind of gel pad. This is surrounded by a tough fibrous ring (annulus fibrosis), which fixes the disc in position. With age, the water content and thus the elasticity of the disc decreases. The fibrous ring consequently starts to have small cracks and the nucleus pulposus may bulge outwards (protrusion). If the nucleus pulposus breaks the annulus, then it is said that a lumbar disc herniation has occurred (slipped disc).
The most frequent (about 90% of cases) location for a herniated disc occurs in the lumbar spine (LWS) also referred to as lumbar disc herniation. Much less frequently (in about ten percent of cases) a herniated disc occurs in the cervical spine.
Depending on where the core slips, if it pushes against a nerve or the spinal cord, it may cause stinging, debilitating pain. Otherwise, it may also be that a herniated disc causes no pain and remains undetected for years. In addition, the area in which a herniated disc is also plays a role in the symptoms it presents. Most commonly, it occurs at the lumbar spine (LS), relatively rare, the cervical spine (cervical) is affected.
Usually a slipped disc in the lumbar region goes first with symptoms such as pain in the back along which later spread also in the legs and feet. When a herniated disc in the cervical spine occurs, it usually involves a tingling pain around the shoulders, arms and hands.
There are a few other symptoms that may indicate a slipped disc depending on where it occurs, how big it is and whether nerves or nerve roots are involved. These involve:
- Sciatical pain
- Loss of nerve function in the arms or neck
- Numbness or tingling
- Loss of certain motor functions
- Increased pain when standing or sitting for prolonged periods
- Muscle weakness
If the disc presses against the spinal cord, pain in arms and legs can be very intense, with numbness accompanied and tingling. Even the sphincter muscles of the bladder and bowel may be impaired. Whether a herniated disc needs surgery will have to be decide by a doctor, or whether physical therapy may be better suited.
Without the discs in between the vertebrae our spines would be stiff. Flexibility in the back is in fact only thanks to the small elastic discs which act as a buffer between the individual vertebrae. They consist of a nucleus pulposus, which is surrounded and held together by a solid fiber ring. These shock absorbers suck at night like sponges liquid and nutrients from the tissue fluid on to them during the day leave when loaded again.
With age, the intervertebral discs but lose the ability to regenerate and maintain themselves. This is not only for the soft, less elastic core but also the protective ring which is porous and forms cracks. This allows fluid to leak from the core and spread in the surrounding tissue. Among other causes for herniated discs include:
- Being overweight
- Lack of exercise
- Constant sitting and heavy lifting
A slipped disc can only usually be diagnosed by a medical examination. The doctor may question the patient about the typical symptoms a herniated disc may present. He or she can then examine the patient and check whether a nerve root is possibly compressed. Thus, the physician obtains a reference to the possible location of the herniated disc.
To gain a more accurate look at the exact location of the herniated disc, a computer tomography (CT) or magnetic resonance imaging (MRI) scab may be carried out, although these would only usually occur if the patient is in excruciating pain whereby surgical intervention may be required.
In approximately 70 -90% of patients with a slipped disc, the symptoms will usually resolve themselves spontaneously or improve significantly means of conservative therapy. For some sufferers, the symptoms can even disappear completely after a few weeks.
A CT or MRI scan can help a doctor detect the severity of a herniated disc, and propose a method of treatment. In most cases the patient’s treatment will consist of analgesic pain medication, heat and targeted physiotherapy which aims to relief pressure on the trapped nerves, or help with the regeneration of the herniated discs.
Severe pain can be alleviated by the doctor, if he or she decides to use a local anaesthetic injection. Surgery is rarely necessary and only about 10% of cases require an invasive operation (herniated disk surgery).Here the destroyed disc tissue is simply removed. Even with this, there isn’t always a guarantee that the pain will stop after the procedure, additionally the scar tissue can proliferate and even press on the nerve, which can recur the pain.
To really get rid of discomfort after suffering from a slipped disc, sufferers need to become active, with a lot of stretching and movement. Whether regular walks or targeted back training, everything that builds up the back and abdominal muscles, will also help the intervertebral discs.