Herniated Disc

Herniated Disc

Discs are donut shaped cartilage with the nucleus pulposus (aka the jelly) in the middle With a herniated disc the nucleus pulposus leaks out of the center and pushes on the spinal cord. This is most common in the lumbar spine, followed by cervical spine. Thoracic disc herniations are rare.

Signs and Symptoms

Signs and symptoms vary based on the severity and location and the herniated disc. We can group these into lumbar and cervical herniation symptoms Lumbar Symptoms -Low back pain -Numbness and tingling in one or both legs -Weakness in one or both legs -Occasional loss of bladder control (only severe cases) Cervical Symptoms -Neck pain -Weakness in one arm -Tingling or numbness in one arm -Burning pain in arm, neck, or shoulders.

Etiology

The disc ruptures when the nucleus pulposus pushes through the outer edge of the disc and back towards the spinal cord. Can happen for multiple reasons. As we age the water content in our discs decreases, causing them to shrink, putting us at risk. Other risk factors include: -Improper lifting -Smoking -Excessive body weight -Repetitive strenuous activity -Sudden pressure

Treatments

The nucleus pulposus will not pop back in on its own so treatments are usually pretty invasive Options include: Disc replacement: the whole disc or just the nucleus pulposus. Epidural injections: used to treat pain but normally not a long term fix. Laprascopic spine surgery: removal of disc and (occasional) fusion of vertebra Minimally invasive Lumbar microscopic discectomy: removal of disc material that has been expelled from the disc.

Evaluation and Diagnosis

There are multiple ways to diagnose a herniated disc if doctors believe you have one, but they all involve imaging to get a better look at the disc because it is so deep. -MRI (most popular and most accurate) -CT scan -Discography: aka discogram, it uses imaging to direct an injection of contrast material into the center of spinal discs to help identify the source of back pain -X-ray (least popular)