Everything You Want to Know About Herniated Discs
Author: Dr. Hamid Abbasi
DATE: 16 Apr 2019
Herniated Discs – An Overview
Herniated discs are one of the more common causes of back pain. Symptoms can range from mild to extreme back pain, as well as sensory issues in the back and extremities. Many patients want to know whether a herniated disc will get worse if left untreated. In this article we are going to answer that question, and also provide answers to several other questions, including:
- What is a herniated disc?
- How to differentiate between a herniated disc, a bulging disc, facet joint inflammation and a muscle tweak: causes and symptoms
- Sitting: Does it hurt or help your herniated disc?
- What are the treatment options for your herniated disc?
- Herniated disc surgery recovery: What can I expect?
- When is a herniated disc healed?
- What is reherniation and how can I prevent it?
- How Inspired Spine can help and how to contact us.
What is a Herniated Disc?
You may remember from high school biology class that your spine is made up of a total of 33 bony segments called vertebrae. The cervical spine makes up your neck and has 7 vertebrae, the thoracic spine consists of 12 vertebrae which make up the middle portion of your back, and the lumbar spine has 5 vertebrae which make up your lower back. A herniated disc can occur anywhere along the spine.
The spinal canal allows very little extra space around the spinal cord. Between each segment of vertebra is a disc that provides cushioning to stop the bones from (painfully) bashing into each other.
The discs between the spinal vertebrae are quarter-sized cushions which are made up of cartilage and consist of two important parts, a soft and gel-like substance (nucleus pulposus) that is protected by thick tissue which makes up the outer portion of the disc (annulus fibrosis).
The discs function as “shock-absorbers” so that the vertebrae don’t touch each other, to protect these bones from injury and to allow mobility in the spine. A herniated disc occurs when the outer layer tears or ruptures and the inner gel-like center leaks into the spinal canal.
Discs show signs of wear and tear as they age, and over time may dehydrate and stiffen up. This process can start at about age 30 and progress slowly as you age. This can cause the outer portion of the disc to become weak, allowing the gel-like insides to bulge out, releasing chemical irritants that can cause nerve pain due to inflammation and irritation.
Do You Have a Herniated Disc or Is It Something Else?
Getting an accurate diagnosis is paramount to a successful treatment strategy. But that’s easier said than done. As a first step, it’s essential to differentiate between a herniated disc, a bulging disc, a facet joint inflammation, and a muscle tweak in the back.
Herniated Disc Pain & Symptoms
When the thick outer layer of the disc tears or ruptures, the gel-like material leaks out of it. This is regarded as herniated material.
This rupture of the disc can be caused by too much pressure being applied to the vertebral column through injury or trauma, which can result in either compression of the nerves coming out of the spinal column, or chemical compounds in the material irritating and inflaming the nerve roots.
This bulge can press on nerves in the area which “think” they are being activated by pain in the body and shoot messages up the brain, saying that there is damage somewhere in the body.
When this happens, you will experience issues such as back pain, pain in the area that is supplied by the affected nerve(s), numbness and/or weakness of the afflicted area, and increased reflexes and spasticity of the involved anatomy. If the spinal cord is involved in the area where the disc ruptures, then total paralysis of the legs may occur.
Herniated discs, also known as slipped discs or ruptured discs, often lead to pain, numbness, and loss of mobility. The pain caused by a slipped disc in the spine can be constant, or it can come and go over time, and can vary significantly by patient. Some will experience constant sharp back pain in the back or in the area supplied by the affected nerve(s), or numbness or weakness of limbs, while others may notice milder pain that recurs over time.
It’s largely a matter of how the herniated disc is interacting with the spinal nerves and surrounding structures. It’s all very patient-specific, which is all the more reason to visit a spine specialist if you suspect you have an issue.
Herniated spinal discs can be caused by several factors, including:
- Acute injury due to car accidents, sports injuries, slip and fall accidents, etc.
- Spinal disc degeneration over time
- Other pre-existing conditions
Herniated vs. Bulging Discs
If only a quarter to half of the perimeter of the disc is impacted, rather than the nucleus pulposus protruding from the entire perimeter of disc, it’s known as a bulging disc.
Bulging disc symptoms include pain in the back or neck, pain along the spine, tenderness or swelling along the spine, tingling, numbness or loss of feeling in the back or extremities, or bladder or bowel issues.
The real challenge with bulging discs is that they can interfere with the nerves in the spine and cause sensory difficulties. If left untreated, they can permanently damage the nerves in your spine and cause numbness or even paralysis. That’s why it’s a good idea to seek treatment if you notice any of these bulging disc symptoms.
Bulging Disc Treatments
You can treat the symptoms of the bulging disc conservatively with injections, pain medications, and bulging disc exercises. Again, when these conservative treatments become ineffective in treating your pain, its worth researching minimally invasive spinal surgery.
Facet Joint Inflammation
Various things can cause the facet joints in your spine to swell up, including degeneration, acute injury, and other spinal conditions. Symptoms of facet joint inflammation include intermittent pain in the back that recurs every few weeks or months for short periods, and tenderness and swelling in the area of inflammation.
Facet Joint Inflammation Treatments
Treatment for facet joint inflammation is not as straightforward as other spinal conditions. The pain caused by facet joint inflammation can mimic similar symptoms of a herniated disc, a bone fracture, or a muscle tear. It is imperative that the diagnosis is made by an experienced orthopedic surgeon.
Once all other conditions have been ruled out, a treatment plan based on your specific symptoms would be created for you. This could include physical therapy, an exercise regimen, pain management, and in severe cases MIS spinal surgery.
Did You Tweak a Muscle in Your Back?
Muscle tweaks or strains can result from car accidents, sports, and exercise. Symptoms of a muscle strain in the back can include pain in specific areas of the back and muscle twitches or back spasms. If you’re planning on participating in physical activity, ensure you properly stretch before and after you get exercise.
Muscle Tweak Treatments
Generally, if you have a muscle tweak, it can be treated without any invasive measures. You’ll generally want to keep your injured muscle out of the game for a while. Speak with your doctor about what treatment options would be best for the muscle you may have strained.
Sitting: Does It Hurt or Help Your Herniated Disc?
When most people are in pain, their first instinct is to find a place to sit down. But for a herniated disc and many other spinal conditions, sitting can exacerbate an existing disc herniation in the spine and make the pain even worse.
Especially for herniated discs in the lower back, sitting can increase pain and other bulging disc symptoms. This is because sitting down puts more tension on the nerves in the lumbar spine. Sitting for long periods of time however, is typically not enough to cause a disc to herniate or bulge.
Conservative Treatments for Herniated Discs
Herniated discs in the spine should be taken very seriously. In rare cases, the symptoms of the condition may subside overtime, without any medical intervention. This has been known to occur because of an immune response by the body that detects the herniated disc as a foreign material, absorption of water in the herniated disc that causes the affected segment to shrink, or natural disc mechanisms can that affect the symptomatic portion of the disc.
These factors can reduce the size of the herniation and lessen the symptoms, but they do not heal the disc. In most cases, if left untreated, a herniated disc will get worse as the spine degenerates over time, or due to additional trauma or injury to the spine. Ignoring a herniated disc can lead to immense pain, and even paralysis, if any nerves are impacted.
Additionally, bulging, ruptured or herniated discs can lead to spinal stenosis, a condition that occurs as the spinal canal narrows. restricting or compressing the nerve roots and spinal cord. This narrowing of the spinal canal often happens in the lower back (lumbar spine) and neck (cervical spine) or, on rare occasion, in the thoracic region of the spine (upper back).
A bulging disc or fragments from a herniated disc, can protrude into the spinal canal or pinch on the nerve extending through the foramen. Ligaments connecting the vertebrae may also degenerate and allow the vertebrae to shift, which can cause a pinched nerve or pinch the spinal cord. When the disc presses on the sciatic nerve, it can cause sciatic nerve pain, also known as sciatica.
Below are a few of the many non-surgical ways to treat pain symptoms associated with a herniated disc. Although these methods temporarily alleviate the symptoms of a herniated disc, over time they may not work as well – leading you to consider MIS spinal surgery.
Many patients find that treatment of a herniated disc with simple painkillers is not enough to get them through the day. Most family doctors will recommend simple NSAIDs or addictive opioids. Neither option is a great long-term solution. Pain medication may include acetaminophen, non-steroidal anti-inflammatories such as ibuprofen and naproxen, and narcotics such as codeine. The latter are reserved for severe back pain due to their ability to potentially lead to drug abuse.
Spinal injections last much longer than taking pills every day and often provide the pain relief patients suffering from a herniated disc need. Steroid medications can also be injected into a layer of the spine called the epidural space to reduce inflammation and irritation to the nerve roots caused by the leaked disc material.
Massage & Physical Therapy
Some therapists can provide pain relief simply using massage therapy. This can provide temporary relief of symptoms, yet is not a cure-all.
With physical therapy, stretching and strength exercises can also be tried to counter muscle imbalances that may have been present for years.
Non-Surgical Spinal Decompression
A non-surgical approach known as spinal decompression has gained popularity recently. People suffering from symptoms of a herniated disc can consider this advanced non-surgical solution for acute aches and pains that may otherwise require surgical intervention.
The procedure involves using a traction table or similar motorized device to stretch the spine. The devices employ the same principles of spinal traction as used by chiropractors and other trained health professionals. The spine is stretched and relaxed periodically to create a negative intradiscal pressure. The treatment is divided over a course of one month, with daily treatments of 30 minutes each.
The spinal decompression procedure is carried out on one of two motorized table options. One option is a table that has the patient lying face down in prone position. The other type of table has the patient lying supine or face up. Both types aim at pulling the herniated soft material back into place and promoting the passage of nutrients back into the disc, boosting healing.
While it may seem fairly straight-forward, the non-surgical spinal decompression procedure is not recommended for everyone. Exceptions can include:
- Expectant women
- Individuals with broken vertebrae
- Individuals having undergone spinal fusion
- Individuals with implants or artificial discs in their spine
- Individuals with failed disc(s)
- Individuals with multiple surgeries
Benefits reported from using non-surgical spinal decompression include:
- Non-invasive treatment
- Drug-free treatment
- Restores normal spine and joint alignment
- Relieves pain
- Relieves pressure on spinal nerves
- More cost-effective than surgery
- No extensive recovery time
Footnote Regarding Non-Surgical Spinal Decompression:
While it’s true that the theory of spinal decompression is considered valid by most practitioners, and that the procedure is FDA approved and considered beneficial as an alternative to prescription painkillers, only limited evidence is available to warrant that the routine use of non-surgical spinal decompression is effective. More research is needed to establish the safety and effectiveness of the procedure.
Herniated Disc Surgery
Depending on the extent of the disc herniation you’re experiencing and various other factors, there are several procedures that may work for you. Traditional open surgery has been the standard of care in the past, but recently several non-invasive procedures are coming to the fore including microdiscectomy, laminoplasty, spinal fusion, spinal laminectomy and total artificial disc replacement.
Herniated Disc Surgery Recovery
What Can I Expect?
The following post-operative care information is based on patients who have had minimally invasive spinal surgery at Inspired Spine.
Herniated disc surgery recovery times depend on the procedure that is performed and on the patients themselves. It can vary from days to months. It’s important to remember that patients should rest after the procedure, and that they cannot immediately return to work.
Traditionally, even in the most resilient of patients, spinal surgery has required several weeks away from work, but with more modern techniques some patients have been able to get back to their jobs in as little as one week.
Immediately after surgery, a nurse will monitor you in the recovery room for 60-75 minutes. Expect numbness of the lower back for a few hours. After the anesthetic wears off, you may experience mild soreness of the surgical site. The nurse will administer pain medications to relief your discomfort.
Most patients will go home the same day of surgery, or the very next day. Before going home, the patient meets with the physical therapist who will work with him/her at home. The physical therapist also instructs the patient on getting in and out of bed and using a walker or assistive device. Because of the manipulation of tissues and healing spine, patients must avoid lifting more than five pounds, bending at the waist, and twisting for 2-4 weeks. In addition, patients should avoid sitting in the same position for more than 45 minutes during the first 2 weeks after the procedure.
Occasionally, patients are given a small, soft lumbar corset to offer support of the lower back in the early postoperative period. The wound area is usually covered with a bandage for the first 24-48 hours but can be left open to air once you go home. The sutures are removed within 7-14 days after you return to the follow-up appointment.
The wounds are to be kept clean and dry. Patients may shower right after surgery but should cover the incision with a bandage to avoid water hitting the wound. The surgical sutures must be left in place. The patient cannot soak in a tub or pool until the wound is healed and sutures are removed.
For optimal post-surgical outcomes, specialist surgeons make the following recommendations to patients:
- Physical therapy needs to be initiated the day after the procedure is performed. This is to help teach the patient the correct movements they need to make to avoid injury and what exercises to perform to strengthen the muscles around the previously herniated disc to offer support to the spine.
- Patients must wait at least one week before heading back to work. Those who have physically demanding jobs may have to wait until they have fully recovered, which is around six weeks after the procedure, at which time normal physical activities without restrictions may commence.
When Is a Herniated Disc Healed?
Once the procedure is performed and the disc material is reabsorbed back into the disc, then surgeons consider the herniated disc healed. This will remain so as long as the patient is aware that any excessive physical exertion may result in a relapse of the condition, reherniation.
If this happens patients may not be fortunate enough to qualify for a minimally invasive procedure and so may have to settle for open surgery to manage the pathology.
What Is Disc Reherniation?
A reherniation occurs when a spinal disc herniates or slips after the patient has already had corrective surgery. This can be the same spinal disc that was previously operated on, or another disc in the spinal cord.
A reherniated disc is a rare occurrence, but can happen from time to time, for a variety of reasons.
How to Prevent and Treat Disc Reherniation?
There are a few things you can do to prevent a reherniated disc after spinal surgery. First, and most importantly, always follow your surgeon’s post-op instructions. Being too active, or otherwise disregarding your surgeon’s recommendations can lead to a reherniation, which will require additional treatment.
When a disc herniates after surgery, you’re pretty much back where you started. You can either treat the issue with conservative methods like painkillers, physical therapy, and injections, or you can undergo a minimally invasive surgical procedure to clear up the herniated disc and stabilize the spine. Surgery is typically the best option, as it offers the most long-lasting pain relief.
Get Rid of Back Pain
Contact Inspired Spine Today
Inspired Spine is dedicated to the conservative treatment of back pain & spinal conditions. Our lead surgeon, Dr. Hamid R. Abbasi, has spent over 20 years creating revolutionary minimally invasive spinal surgery techniques with shorter procedure times, substantially less blood loss, and faster recovery times – most often times without the need for a hospital stay.
Whether you or a loved one has a herniated or bulging disc in your spine, a tweaked muscle in your back, are experiencing facet joint inflammation, or are suffering from neck pain, lower back pain or some other back-related pain, Inspired Spine can help. Call us or fill out our online form to schedule your free consultation.