July 5, 2008 · Print This Article
The term disc herniation was first used in 1934 to describe the processes of sciatic pain. Since that time, “disc herniation” is an umbrella term that encompasses many monikers. Terms you may have heard before include:
- Herniated disc
- Slipped disc
- Prolapsed disc
- Protruding disc
- Bulging disc
- Ruptured disc
- Extruded disc
In an effort to avoid the confusion often associated with medical terminology, the term “herniated disc” is divided into 2 categories:
1.) Contained protrusions
2.) Noncontained herniations.
Contained protrusions are localized disc bulges where the annular fibers (outer rings of the disc) remain intact and firmly connected to the bony vertebrae above and below and protrudes beyond the outer rim of the vertebra. Noncontained herniations are actual disruptions of the annular fibers and permit extrusion of the nuclear material (central jelly like portion of the disc).
These conditions mainly affect people between 30 and 50 years of age. Although the disc undergoes a natural aging effect, abnormal stress to the disc in the form of excessive bending, twisting, and lifting can result in disc injury. Disc injury can also result from excessive compression loads on the spine such as those encountered from a fall.
Symptoms associated with a herniated disc include a progressive worsening of low back pain over the course of months or years. Eventually back pain will be replaced with leg pain and the symptoms are worsened with bending forward coughing, or sneezing. Generally lying on your back with your knees bent relieves pain. In rare circumstances, muscle weakness of the legs along with bowel and bladder dysfunction are encountered.
The diagnosis of a herniated disc is made by both clinical examination and diagnostic imaging. A critically important point is that diagnostic imaging alone is insufficient in making a definitive diagnosis. Why? Because the medical literature is VERY clear on the matter - as high as 85% of people walking around with no back pain will have MRI/CT scan evidence of disc “pathology”. Therefore, positive imaging findings without corroborating clinical exam findings mean NOTHING. Yet it’s the first thing doctors will point to when trying to explain a person’s back pain.
Clinical examination entails taking a comprehensive history and performing a physical assessment. The accuracy of your report of symptoms will help your doctor determine the potential source of your symptoms. In addition, specific testing to determine strength, mobility, and nervous system integrity will begin to clarify the source of the problem.
X-rays are of little value in diagnosing disc herniations. The discs are essentially invisible to X-rays and provide the examiner very little information other than evidence of narrowing of the disc space, which is a normal consequence of the aging process.
CT scans provide a more detailed view of the disc and lets doctors see if a herniated disc is putting pressure on a spinal nerve.
Myelograms are used to pinpoint the precise level of disc herniation. To perform this test, a special dye is injected into the space around the spinal canal and an x-ray or CT scan is performed. Disruption in the pattern of the dye helps clearly identify disc herniation.
Magnetic Resonance imaging (MRI) provided markedly improved images of the soft tissues over that of CT scans. MRI scans of the low back very clearly show the difference between a healthy disc (appears white on the film) and an unhealthy disc that appears black on the film. In addition, the presence of a herniated disc is clearly evident.
Discograms involve injecting a dye into the disc. The response of the dye once within the disc is observed on x-ray or CT scan and provides information on the health of the disc. Spine surgeons will use this test when surgery is being considered to determine which disc is causing problems.
Electromyography (EMG) measures how long it takes a muscle to work once a nerve is stimulated. This test is utilized to help localize radiculopathy to a particular nerve or in patients with minimal findings or normal examination.
The goals of treatment for a herniated disc are reduction of symptoms and improved function. In the old days, bed rest was recommended but we now know that staying active is far better than inactivity.
To help a person maintain activity a back support is often used for patients with lumbar disc herniation. The properly designed brace can provide external support to the trunk while unloading the spinal elements. Read more about back supports here ===> Back Supports
Medications are often prescribed for patients with a herniated disc. Typically, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics (pain medications), and muscle relaxants are initially administered. In cases of severe sciatica, oral steroids may also be prescribed.
At this stage, physical therapy treatment can be incorporated into the plan of care. A summary of the role of the physical therapist can be found here ===> Physical Therapy For Back Pain
Epidural Steroid Injections (ESI) are used for both diagnostic and therapeutic purposes. The treatment involves injection of a steroid into the epidural space of the spinal canal to help reduce inflammation of the nerve root. Learn more about epidural steroid injections here ===> Epidural Steroid Injections.
Surgery: Most people with a herniated disc get better without surgery. But when patients simply aren’t getting better, or if the problem is becoming more severe, surgery may be suggested. Indications for surgery include weakness of the leg muscles, intractable pain, changes in neurological status, and failure to respond to conservative treatment. Surgical treatment for disc herniation includes laminectomy, discectomy, and fusion. Learn more about surgery as a treatment option for disc herniation here ===> Back Surgery For A Herniated Disc
If you’ve been diagnosed with a herniated disc and would like some professional advise on what to do about it, you can arrange for a free phone consultation here === > Free Phone Consultation
Written by Malton A. Schexneider, PT, MMSc