Herniated disc: symptoms, diagnosis, treatment
A slipped disc (disc prolapse, herniated disc) occurs most frequently in people between 30 and 50 years of age. Often it does not cause any complaints. But it can also cause severe back pain, sensory disturbances and even paralysis – in which case quick action is important. Read here everything about symptoms, examinations and therapy of the herniated disc!
Herniated disc: short overview
- Possible symptoms: depending on the height and extent of the incident, e.g. back pain that can radiate into a leg or arm, sensory disturbances (formication, tingling, numbness) or paralysis in the leg or arm concerned, bladder and bowel emptying disorders
- Causes: mostly age- and stress-related wear and tear, as well as lack of exercise and overweight; more rarely injuries, congenital malposition of the spine or congenital weakness of the connective tissue
- Important research: Physical and neurological examination, computer tomography (CT), magnetic resonance imaging (MRT), electromyography (EMG), electroneurography (ENG), laboratory tests
- Treatment options: Conservative measures (such as light to moderate exercise, sports, relaxation exercises, heat applications, medication), surgery
- Prognosis: symptoms usually disappear on their own or with the help of conservative therapy; surgery not always successful, complications and relapses possible
Herniated disc: Symptoms
In some patients a herniated disc causes symptoms such as pain, a tingling or formication in arms or legs, numbness or even paralysis in the extremities. The reason for the discomfort is that the inner core of the disc emerges and presses on nerves at the spinal canal.
The spinal column consists of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae as well as the sacrum and the coccyx.
Symptoms are not always present
Not every herniated disc causes symptoms such as pain or paralysis. It is then often only discovered by chance during an investigation.
If a slipped disc causes symptoms, this indicates that the slipped disc is pressing against individual nerve roots, the spinal cord or the nerve fiber bundle in the lumbar spine (cauda equina = horse’s tail).
In the case of a slipped disc, the slipped disc presses on the nerves originating at the spinal cord (spinal nerves) and can thus cause discomfort.
Herniated disc – symptoms with pressure on nerve roots
Which herniated disc symptoms occur when pressure is applied to a nerve root depends on the height at which the affected nerve root is located – in the lumbar, thoracic or cervical spine.
Slipped disc – lumbar spine:
Symptoms of a herniated disc almost always originate in the lumbar spine, because the body weight exerts a particularly strong pressure on the vertebrae and discs. Doctors speak of lumbar disc herniation or “herniated disc lumbar spine”. Symptoms are usually caused by herniated discs between the 4th and 5th lumbar vertebrae (L4/L5) or between the 5th lumbar vertebra and the 1st coccyx (L5/S1).
The pressure on nerve roots in the lumbar spine causes sometimes severe pain in the lower back area, which can radiate into the leg (along the supply area of the affected nerve root). Neurological deficits such as sensory disturbances (such as formication, tingling, numbness) and paralysis in this area are also possible.
It is particularly unpleasant if the sciatic nerve is affected by the lumbar disc herniation. This is the thickest nerve of the body. It consists of the fourth and fifth nerve roots of the lumbar spine and the first two nerve roots of the sacrum. The pain caused by his pinching is often described by patients as shooting or electrifying. They run from the buttocks over the back of the thigh down to the foot. The symptoms are often intensified by coughing, sneezing or movement. Doctors call this symptom sciatica.
Slipped disc – cervical spine:
Occasionally, a herniated disc in the cervical spine area (cervical disc herniation or cervical spinal disc herniation) occurs. It preferentially affects the disc between the 5th and 6th or the 6th and 7th cervical vertebrae. Doctors use the abbreviations HWK 5/6 and HWK 6/7 for this purpose.
Symptoms of a slipped disc in the cervical spine area can be pain radiating into the arm. Other possible symptoms are paraesthesia and muscle paralysis in the area where the affected nerve root spreads.
Herniated disc – thoracic spine:
A slipped disc in the thoracic spine is extremely rare. The diagnosis here is “thoracic disc herniation” (or in short: “disc herniation BWS”). Symptoms can be back pain, which is usually limited to the affected section of the spine. Only rarely does the pain radiate into the supply area of the compressed nerve.
Symptoms of herniated discs when pressure is applied to the spinal cord
The spinal cord extends from the brain stem to the first or second lumbar vertebrae. If a herniated disc presses on the spinal cord, intense pain in one leg or arm as well as sensory disturbances (formication, tingling, numbness) can occur. Also an increasing weakness of both arms and/or legs are possible consequences of a herniated disc. Indications that the herniated disc is pressing on the spinal cord may also be functional disorders of the sphincters of the bladder and intestines. They are accompanied by numbness in the anal and genital area and are considered an emergency – the patient must go to a hospital immediately!
Symptoms of herniated discs with pressure on the horse’s tail
The spinal cord continues at the lower end in a bundle of nerve fibres, the horse’s tail (cauda equina). It extends to the sacrum, an extension of the spine.
Pressure against the horse’s tail (cauda syndrome) can cause problems with urination and bowel movements. In addition, those affected no longer have any feeling in the area of the anus and genitals or on the inside of the thighs. Sometimes even the legs are paralyzed. In case of such symptoms you must also go to the hospital immediately!
Alleged symptoms of herniated disc
A herniated disc does not always trigger symptoms such as back pain – even if the X-ray shows a prolapse. Sometimes tension, spinal changes (e.g. due to wear and tear, inflammation) or neurological diseases are the cause of supposed symptoms of a slipped disc. Pain in the leg is also not a clear sign – herniated disc with pressure on a nerve root is only one of several possible explanations. Sometimes there is a blockage of the joint between the sacrum and the pelvis (sacroiliac joint blockage). In most cases, leg pain in back pain cannot be attributed to a nerve root.
In fact, about 60 percent of the population suffer from back pain without a herniated disc. However, if the pain radiates into the leg, those affected should see a doctor. Sensory disturbances such as formication, tingling or numbness are also often typical for a herniated disc.
Of course, this depends on how extensive the damage is and whether the herniated disc is acute. In the long term, targeted movement is particularly important: stretching and extension exercises, isometric training with building up the deep muscles, stabilising exercises and then building up muscles on the machine. Only in cases of paralysis and/or severe pain that persists for more than six months is an operation useful.
Herniated disc: examinations and diagnosis
If your back pain is unclear, the first thing you should do is go to your family doctor. If a herniated disc is suspected, he can refer you to a specialist. This could be a neurologist, neurosurgeon or orthopaedic surgeon.
To determine a herniated disc, it is usually sufficient to interview the patient (anamnesis) and a thorough physical and neurological examination. Imaging procedures (such as MRI) are only necessary in certain cases.
In order to clarify the suspicion of a herniated disc, the doctor will first discuss the patient’s medical history (anamnesis). For example, he asks this question:
- What complaints do you have? Where exactly do they perform?
- How long have the complaints existed and what has triggered them?
- Does the pain intensify when you cough, sneeze or move, for example?
- Do you have problems urinating or defecating?
The information helps the doctor to narrow down the cause of the complaints and to estimate from which part of the spine they might originate.
Physical and neurological examination
The next step is physical and neurological examinations. The doctor performs palpation, tapping and pressure examinations in the area of the spine and back muscles in order to detect abnormalities or points of pain. It also tests the range of motion of the spine. In addition, muscle strength, feeling in the affected arms or legs and reflexes are tested. The type and location of the complaints often already give the doctor an indication of the height of the spine at which a herniated disc is present.
Computer tomography (CT) and magnetic resonance imaging (MRT) can make a herniated disc visible. The doctor then recognises, for example, the extent of the incident and the direction in which it occurred: In most cases a mediolateral herniated disc is present. The gelatinous core has slipped between the intervertebral holes and the spinal canal.
A lateral herniated disc can be recognized by the fact that the gelatinous core has slipped away to the side and exits into the intervertebral holes. If he presses on the nerve root of the affected side, unilateral complaints result.
A medial herniated disc is more rarely present: The gelatinous mass of the disc nucleus emerges here centrally towards the back in the direction of the spinal canal (spinal canal) and can press directly on the spinal cord.
When are imaging procedures necessary for herniated discs?
A CT or MRI is only necessary if a doctor’s consultation or physical examination has revealed an indication of a clinically significant herniated disc. This is the case, for example, if paralysis occurs in one or both legs, if the bladder or bowel function is disturbed or if severe symptoms persist for weeks despite treatment. MRI is usually the first choice.
Imaging is also necessary when back pain is accompanied by symptoms that indicate a possible tumor (fever, night sweats or weight loss). In these rare cases, the space between the spinal cord and the spinal sac (dural space) must be visualized with an X-ray contrast medium (myelography or myelo-CT).
A normal X-ray examination is usually not useful if a herniated disc is suspected, because it can only show bone, but not soft tissue structures such as intervertebral discs and nerve tissue.
Imaging techniques are not always helpful
Even if a herniated disc is detected in the MRI or CT, it does not necessarily have to be the cause of the complaints that led the patient to visit the doctor. In many cases, a herniated disc runs without symptoms (asymptomatic).
In addition, imaging techniques can contribute to the patient’s pain becoming chronic. Because looking at a picture of one’s own backbone can obviously have a negative psychological effect, as studies show. Particularly in the case of diffuse back pain without neurological symptoms (such as sensory disturbances or paralysis) one should therefore wait and see. Only if the symptoms do not improve even after six to eight weeks is an imaging examination indicated.
Computer tomography (CT) or magnetic resonance imaging (MRT) are used to clarify a herniated disc.
Measurement of muscle and nerve activity
If a paralysis or sensory disorder occurs in arms or legs and it is unclear whether it is the direct result of a herniated disc, electromyography (EMG) or electroneurography (ENG) can provide certainty. With the EMG, the treating physician uses a needle to measure the electrical activity of individual muscles. In cases of doubt, the ENG can reveal exactly which nerve roots are squeezed by the herniated disc, or whether another nerve disease is present, for example polyneuropathy.
In rare cases, certain infectious diseases such as Lyme disease or herpes zoster (shingles) can cause similar symptoms to a herniated disc. If the imaging shows no findings, the doctor can therefore take a blood sample from the patient and possibly also a sample of cerebrospinal fluid (cerebrospinal fluid). These samples are examined in the laboratory for infectious agents such as Borrelia or Herpes Zoster viruses.
The doctor can also arrange for the determination of general parameters in the blood. These include inflammation values such as the number of leukocytes and the C-reactive protein (CRP). These are important, for example, if the symptoms could also be caused by an inflammation of the intervertebral disc and adjacent vertebral bodies (spondylodiscitis).
Herniated disc: treatment
Most patients are mainly interested in: “What to do in case of herniated disc?”. The answer depends mainly on the symptoms. In more than 90 percent of patients a conservative treatment of herniated disc is sufficient, i.e. a therapy without surgery. This is especially true if the herniated disc causes pain or a slight muscle weakness, but no other / more severe symptoms.
These include, above all, paralysis and disorders of the bladder or rectum function. In such cases surgery is usually performed. Even if symptoms persist despite conservative treatment for at least three months, surgical intervention can be considered.
Herniated disc: treatment without surgery
In the context of conservative treatment of herniated discs, doctors today rarely recommend immobilization or bed rest. However, in the case of a cervical disc herniation, for example, it may be necessary to immobilize the cervical spine with a cervical collar. In case of severe pain due to a herniated disc of the lumbar spine, a stepped bed positioning can be helpful for a short time.
In most cases, conservative herniated disc therapy includes light to moderate movement. Normal everyday activities are therefore advisable – as far as the pain allows. Many patients also receive physiotherapy as part of outpatient or inpatient rehabilitation. The therapist practices painless movement patterns with the patient and gives tips for activities in everyday life.
Even in the long term, regular exercise is very important in the case of a herniated disc: On the one hand, the alternation between loading and unloading the discs promotes their nutrition. On the other hand, physical activity strengthens the trunk muscles, which relieves the intervertebral discs. Therefore, exercises to strengthen the back and abdominal muscles are highly recommended in the case of a slipped disc. Physiotherapists can show patients these exercises as part of back training. Patients should then exercise regularly themselves.
In addition, you can and should do sports if you have a slipped disc, as long as it is disc-friendly. This applies, for example, to aerobics, running, back swimming, cross-country skiing and dancing. Less good for the intervertebral discs are for example tennis, downhill skiing, football, handball and volleyball, golf, ice hockey, judo, karate, gymnastics, canoeing, bowling, wrestling, rowing and squash.
If you do not want to do without such a sport that is harmful to the intervertebral discs, you should do some exercise and strength training to compensate, for example, running, cycling or swimming regularly. In case of uncertainty, patients should discuss the type and extent of sports activities with their doctor or physiotherapist.
Many people with back pain due to a slipped disc (or for other reasons) also benefit from relaxation exercises. These can, for example, help to relieve pain-related muscle tension.
Heat applications have the same effect. Therefore, they are also often part of the conservative treatment for herniated discs.
If necessary, drugs are used for herniated discs. These include above all painkillers such as non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac etc.). In addition to an analgesic effect, they also have an anti-inflammatory and decongestant effect. Other active ingredients may also be used, such as COX-2 inhibitors and cortisone. They also have an anti-inflammatory and analgesic effect. If the pain is very severe, the doctor can prescribe opiates at short notice.
The pain therapy for herniated discs should be closely monitored by the doctor to avoid serious side effects. Patients should follow the doctor’s instructions exactly when using the painkillers.
In some cases, the doctor will also prescribe muscle-relaxing medication (muscle relaxants) because the muscles can become tense and hardened due to pain and a possible relieving posture. Sometimes antidepressants are also useful, for example in cases of severe or chronic pain.
Slipped disc: When does surgery have to be performed?
Whether a herniated disc surgery should be performed is decided jointly by doctor and patient. The criteria for a disc surgery are:
- Symptoms indicating pressure against the spinal cord (early or immediate surgery)
- severe paralysis or increasing paralysis (immediate operation)
- Symptoms indicating pressure against the horse’s tail (cauda equina) (immediate operation)
- diminishing pain and increasing paralysis (quick operation because there is a risk that the nerve roots are already dying off)
There are various techniques for surgical treatment of herniated discs. Microsurgical procedures are standard today. They reduce the risk of scarring. Alternatively, in certain cases, minimally invasive procedures can be considered for a herniated disc surgery.
Herniated disc surgery: Microsurgical discectomy
The most widely used technique in the surgical treatment of herniated discs is the microsurgical discectomy (discus = intervertebral disc, ectomy = removal). The affected intervertebral disc is removed with the help of a surgical microscope and the smallest special instruments. This should relieve those spinal nerves (spinal nerves) that are constricted by the herniated disc and cause discomfort.
Only small skin incisions are required to insert the surgical instruments. This is why microsurgical operation technology is one of the minimally invasive procedures.
Microsurgical discectomy can remove all herniated discs – no matter in which direction the disc part has slipped. In addition, the surgeon can see directly whether the compressed spinal nerve has been released from any pressure.
Procedure of the operation
The microsurgical discectomy is performed under general anesthesia. The patient is in a kneeling position, with the upper body at a higher level on the operating table. This increases the distance between the vertebral arches and facilitates the opening of the spinal canal.
At the beginning, the surgeon makes a small skin incision above the diseased disc area. Then he carefully pushes the back muscles aside and partially (as little as necessary) cuts the yellowish band (ligamentum flavum) that connects the vertebral bodies. This allows the surgeon to look directly into the spinal canal with the microscope. Sometimes he also has to remove a small piece of bone from the vertebral arch to improve vision.
Using special instruments, he now loosens the prolapsed disc tissue under visual control of the spinal nerve and removes it with grasping forceps. Larger defects in the fibrous ring of the disc can be sutured microsurgically. Parts of the intervertebral discs (sequesters) that have slipped into the spinal canal can also be removed. In the last step of the disc surgery, the surgeon closes the skin with a few sutures.
During the microsurgical disc surgery, the nerve that is to be relieved can be injured. Possible consequences are sensory and movement disorders of the legs, functional disorders of the bladder and bowel, and sexual disorders. However, such complications are rare.
As with any operation, there is a certain risk of anaesthesia and the risk of infections, wound healing disorders and postoperative bleeding.
Even with optimal intervertebral disc surgery and prolapse removal, some patients experience renewed pulling leg pain or, for example, a tingling sensation after weeks or months. This late consequence is called “Failed back surgery syndrome”.
After the operation
As with any operation under anaesthetic, sometimes the bladder has to be emptied with a catheter on the first day after the operation. After a very short time, however, the bladder and bowel function normalizes. Usually the patient can already get up on the evening of the day of the operation.
On the first day after the procedure, physiotherapy exercises are started for the patient with a slipped disc. Psychologists, nutritionists and occupational therapists also work as specialists in the rehabilitation after a herniated disc surgery.
The stay in hospital usually lasts only a few days. Six or twelve months after the microsurgical discectomy, the long-term success of the disc surgery is reviewed. Imaging techniques help in this process.
Slipped disc surgery: Open discectomy
Before the introduction of the surgical microscope, herniated discs were often operated on with the conventional open technique under a larger access (larger incisions). Today, open discectomy is rarely performed, for example in cases of malformations of the spine. Their results are comparable to those of microsurgical discectomy. However, serious complications are more frequent.
Procedure of the operation
The open discectomy is essentially the same as the microsurgical disc herniation operation, but larger incisions are made and the surgical area is not assessed with micro-optics but from the outside.
The possible complications of open discectomy are comparable to those of microsurgical discectomy, but occur more frequently.
After the operation
Sometimes the bladder has to be emptied with a catheter on the first day after open disc surgery. Within a very short time, however, the bladder and bowel function returns to normal.
The patient is usually allowed to get up again on the evening of the day of surgery. The next day, physiotherapy exercises are usually started to strengthen the muscles and ligaments of the back again. The patient usually only has to stay in hospital for a few days.
Slipped disc surgery: Endoscopic discectomy
The minimally invasive techniques of a disc surgery include microsurgical methods as well as so-called percutaneous endoscopic methods. The removal of the intervertebral disc is carried out here with the help of endoscopes, video systems and micro instruments (some of which are motor-driven), which are inserted through small skin incisions. The patient is usually in a semi-awakened state and under local anaesthesia. This enables him to communicate with the surgeon.
Endoscopic disc herniation surgery cannot be performed on every patient. It is unsuitable, for example, if parts of the disc have become detached (sequestered disc herniation) and have slipped up or down in the spinal canal. Even in the case of herniated discs in the transition area between the lumbar spine and sacrum, an endoscopic discectomy is not always applicable. Because here the iliac crest blocks the way for the instruments.
By the way: With endoscopic methods, not only the entire intervertebral disc can be removed (discectomy), but if necessary only parts of the gelatinous core (nucleus). Then we speak of percutaneous endoscopic nucleotomy.
Procedure of the operation
The patient lies on his stomach during the endoscopic disc surgery. The skin over the affected spinal column section is disinfected and locally anaesthetised. Through one or two small incisions, one or two small metal tubes are inserted into the disc space under X-ray control. These are working sleeves with a diameter of three to eight millimetres. They allow instruments such as small grasping forceps and an endoscope to be inserted into the disc space. The latter has special lighting and optics. The images from the operating area inside the body are projected onto a video monitor where the operating doctor can see them.
The surgeon can now specifically remove disc tissue that is pressing on a nerve. After the endoscopic disc surgery, he sutures the incisions with one or two stitches or supplies them with special plasters.
The complication rate for endoscopic disc surgery is relatively low. Nevertheless, there is a certain risk of nerve damage. Possible consequences are sensory and movement disorders in the legs and functional disorders of the bladder and intestines.
In addition – as with any operation – there is a risk of infection, wound healing disorders and secondary bleeding.
Compared to microsurgical discectomy, the relapse rate (recurrence rate) is higher in endoscopic disc surgery.
After the operation
If the endoscopic disc surgery went without complications, the patient can get up again within three hours and leave the hospital the same day or the next morning. Physiotherapeutic exercises should be started the day after the operation.
Intervertebral disc surgery with intact fibrous ring
If someone has only a slight herniated disc with the fibrous ring still intact, the affected disc in the area of the gelatinous core can sometimes be reduced or shrunk by a minimally invasive procedure. This relieves the pressure on nerve roots or spinal cord. This technique can also be used for disc protrusions (here the fibrous ring is always intact).
The advantage of minimally invasive procedures is that they require only small skin incisions, are less risky than open surgery and can usually be performed on an outpatient basis. However, they are only suitable for a small number of patients.
Procedure of the operation
In this minimally invasive disc surgery, the skin over the affected spinal column section is first disinfected and locally anesthetized. Sometimes the patient is also put into a twilight sleep. Now the doctor carefully inserts a hollow needle (cannula) into the middle of the affected disc under image control. Through the hollow channel he can insert working instruments to reduce or shrink the tissue of the gelatinous core:
This can be a laser, for example, which allows the gelatinous core inside the intervertebral disc to vaporize through individual flashes of light (laser disc decompression). The gelatinous core consists of over 90 percent water. The volume of the core is reduced by the evaporation of tissue. In addition, the heat destroys “pain receptors” (nociceptors).
In the case of a thermolesion, the surgeon inserts a thermocatheter under x-ray control into the interior of the intervertebral disc. The catheter is heated up to 90 degrees Celsius, so that part of the intervertebral disc tissue boils. At the same time, the outer fibrous ring is supposed to solidify due to the heat. Some of the pain-conducting nerves are also destroyed.
In so-called nucleoplasty, the doctor uses radio frequencies to generate heat and vaporize the tissue.
The doctor can also insert a decompressor into the interior of the intervertebral disc through the cannula. At its tip is a fast rotating spiral thread. It cuts into the tissue and can simultaneously suck out up to one gram of the jelly mass.
In the course of the chymopapain injection the enzyme chymopapain is injected, which chemically liquefies the gelatinous core inside the intervertebral disc. After a certain waiting time, the liquefied core mass is sucked out through the cannula. It is very important here that the fibrous ring of the disc concerned is completely intact. Otherwise, the aggressive enzyme can escape and cause severe damage to surrounding tissue (such as nerve tissue).
One of the possible complications of minimally invasive disc surgery is bacterial disc inflammation (spondylodiscitis). It can spread to the entire vertebral body. Therefore, the patient usually receives an antibiotic as a preventive measure.
After the operation
In the first weeks after a minimally invasive disc surgery, the patient should take it easy on his body. Sometimes the patient is prescribed a corset (elastic bodice) for this period to relieve the strain.
Slipped disc surgery: Implants
As part of the surgical treatment of a herniated disc, the worn disc is sometimes replaced by a prosthesis to preserve the mobility of the spine. The intervertebral disc implant is intended to maintain the distance between the vertebrae as well as their normal mobility and to relieve pain.
So far it is unclear which patients benefit from a disc implant and what the long-term successes will be. Ongoing studies have so far produced quite positive results. However, real long-term results are still missing, especially since most patients are in middle age at the time of the disc surgery, so probably still have some life time ahead of them.
Nucleus pulposus replacement
In the early stages of disc wear (disc degeneration) it is possible to replace only the gelatinous core of the disc (nucleus pulposus). This operation is being further developed and observed in clinical studies worldwide. The artificial gelatinous core acts as a placeholder between the vertebrae and is filled with hydrogel. This gel comes very close to the biochemical and mechanical properties of the natural gelatinous core because it can absorb liquid. Like the intervertebral disc, it absorbs water when relieved and releases it again when pressure is applied.
The disc surgery is performed under general anesthesia. Access to the intervertebral disc is either via a skin incision in the back or minimally invasive from the abdomen. Already on the day after the operation the patient can get up. Little is known about long-term results so far.
Total disc replacement
In total disc replacement, the disc and parts of the base and cover plates of the adjacent vertebrae are removed. In most models, the intervertebral disc replacement consists of titanium-coated base and cover plates and a polyethylene inlay (i.e. very similar to the known hip prostheses).
The procedure of the disc surgery: The old disc is removed; in addition, a part of the cartilage on the base and cover plates of the adjacent vertebrae is rasped away. With the help of x-ray fluoroscopy, the size of the intervertebral disc is determined and a suitable implant is selected. Depending on the model, the surgeon now chisels a small, vertical slit into the base and top plate of the adjacent vertebrae. It serves to anchor the prosthesis. Then the surgeon inserts the disc replacement. The pressure of the spine stabilizes the implant. Within three to six months, bone material grows into the specially coated base and cover plates of the full disc prosthesis.
Already on the first day after the operation the patient can get up. In the first few weeks he must not lift heavy loads and must avoid extreme movements. An elastic girdle, which the patient can put on himself, serves as a stabilisation.
Patients who suffer from osteoporosis (bone loss) or in whom the vertebra to be treated is motionally unstable must not receive a total disc replacement.
Herniated disc: Causes and risk factors
Depending on the severity and location of the herniated disc, different forms are distinguished.
When a disc prolapses – the shock absorber between two vertebrae – the inner gelatinous core of the disc slips. The rough, fibrous sheath (Anulus fibrosus) of the intervertebral disc tears and the gelatinous core emerges. It can press on the nerves originating at the spinal cord (spinal nerves) and thus cause discomfort. Sometimes detached parts of the gelatinous core also slide into the spinal canal. Then the diagnosis is “sequestered herniated disc”.
The cause of a herniated disc is usually an age- and stress-related degeneration of the connective tissue ring of the disc: it loses its stabilizing function and tears under great stress. The gelatinous core can partially leak out, pressing on a nerve root or the spinal cord. The frequency of herniated discs decreases again from the age of 50 onwards, because the disc core then loses more and more fluid and therefore leaks less frequently.
In addition, lack of exercise and overweight are important risk factors for herniated discs. Typically, the abdominal and back muscles are then also weak. Such an instability of the body promotes an incorrect loading of the intervertebral discs, since only strong trunk muscles relieve the spine.
Possible triggers for a herniated disc are also postural defects, jerky movements and sports in which the spine is shaken (riding, mountain biking) or twisted (tennis, squash). The same applies to heavy physical work, such as lifting heavy loads. However, this alone cannot cause a herniated disc. This can only happen if a disc already shows signs of wear and tear.
Less frequently, injuries (such as a fall down the stairs or traffic accident) and congenital malpositions of the spine are the cause of a herniated disc.
In some people, a congenital weakness of the connective tissue contributes to the development of a disc prolapse.
A distinction must be made between a herniated disc (disc protrusion) and a prolapsed disc. Here, the inner disc tissue shifts to the outside without the annulus of the disc rupturing. Nevertheless, complaints such as pain and sensory disturbances can occur. A well-known example is lumbago: This is acute, severe pain in the lumbar region.
Herniated disc: Cervical spine
The age-related wear and tear of vertebral joints and intervertebral discs is the main reason why the cervical spine can show a herniated disc, especially in older people: The vertebral joints loosen and change over the years, and the intervertebral discs wear down increasingly.
The effects of a herniated disc in the cervical spine usually affect shoulders, arms and the chest area, because the supplying nerves leave the spinal cord at this height.
When younger people suffer a herniated cervical disc, the cause is often an injury or an accident. For example, an abrupt rotation of the head can cause a disc to protrude between the cervical vertebrae.
You can read more about causes, symptoms and treatment of a cervical disc prolapse in the article Herniated disc cervical spine.
Herniated disc: course of disease and prognosis
In about 90 out of 100 patients, the pain and movement restrictions caused by an acute herniated disc subside on their own within six weeks. Presumably, the displaced or leaked disc tissue is removed or shifted by the body, so that the pressure on nerves or spinal cord decreases.
If treatment becomes necessary, conservative measures are usually sufficient. They are therefore often the therapy of choice for a herniated disc. The duration of regeneration and chances of recovery depend on the severity of the herniated disc.
Even after a successful treatment, a new prolapse can occur on the same disc or between other vertebral bodies. Therefore, anyone who has survived a herniated disc should regularly exercise their trunk muscles and take further advice on how to prevent a herniated disc (see below).
After an operation
An operation for herniated discs should be carefully considered. Often it is successful, but there are also patients in whom the operation does not provide the desired freedom from pain in the long term. Doctors refer to this as failed-back surgery syndrome or post-discectomy syndrome. It arises because the intervention has not eliminated the actual cause of the pain or has created new causes of pain. These can be, for example, inflammations and scarring in the area of operation.
As a further complication of a disc surgery, nerves and vessels can be damaged during the operation.
For various reasons, a patient may feel worse after a disc surgery than before. Follow-up operations may also be necessary. This can also be the case if patients who have been operated on later have new slipped discs.
A herniated disc should therefore only be operated on if it is urgently necessary, for example because it causes paralysis. Furthermore, the expected benefits should be significantly greater than the risks. In order to improve the results, many patients go to rehabilitation clinics after the operation.
So far, there is no way to find out in advance which patients with a herniated disc benefit most from a disc surgery.
Slipped disc: Prevention
A healthy, strong trunk musculature is the prerequisite for the body to be able to cope with everyday challenges. If you follow some rules, you can do something against a herniated disc. People who have already had a herniated disc should also follow this advice. Preventive measures are among others:
- Pay attention to your body weight: being overweight puts strain on your back and promotes a slipped disc.
- Do sports regularly: especially beneficial for the back are hiking, jogging, cross-country skiing, crawling and backstroke, dancing, water gymnastics and other types of gymnastics that strengthen the back muscles.
- Certain relaxation techniques such as yoga, tai chi and Pilates also promote good posture and help strengthen the trunk and back. This is the best relief for the spine and intervertebral discs.
- If possible, sit upright and on a chair of normal height. Change your sitting position frequently. Accompanying strength training stabilizes the trunk muscles.
- Position objects that you use often at an easily accessible height: Eyes and arms are relieved and you avoid overloading the cervical spine. This is also important for a back-friendly workplace.
- Avoid deep and soft seats; a wedge-shaped seat cushion is recommended.
- Working standing up: The workplace must be high enough to allow you to stand upright (permanently).
- Never lift very heavy objects with stretched legs and flexed spine: Kneel down, keep the spine stretched and lift the load “out of the legs”.
- Distribute the load in both hands so that the spine is equally loaded.
- Do not bend the spine towards the opposite side when carrying loads.
- Keep your arms close to your body when carrying loads: do not shift the weight of your body backwards and avoid a hollow back.
- Make sure that the spine cannot bend, even when you are sleeping. A good mattress (the hardness should correspond to the body weight) plus slatted frame and possibly a small pillow to support the natural shape of the spine.