FAQs on Herniated Disc
What does a normal disc consist of?
At each level of the spine, there is an intervertebral disc. The disc acts as a shock absorber, and normally contains 80% water. As an individual twists and bends, the disc absorbs the stresses nicely by losing and re-absorbing water on a regular basis.
The inner part of the disc is called the nucleus pulposus, and contains no nerve endings.
It does not have the ability to feel any pain. The disc is proverbially a jelly donut, with the nucleus being the jelly inside.
The outer part of the disc, known as the annulus fibrosus, is analogous to the outer part of the jelly donut. This part of the disc contains nerve endings, and does have the ability to feel pain.
Over time, as an individual ages, the amount of water in the disc progressively decreases. This results in disc degeneration, which may or may not be painful. Most disc degeneration, in fact, causes no back pain at all.
What is a herniated disc?
As a disc degenerates, the outer part of the disc can sustain tears. If the tear is large enough, some of the inner jelly can squeeze out, resulting in a herniated disc. Interestingly, just because a disc herniation occurs it may not be painful at all. An individual may end up with back pain due to the tear in the disc.
If the part that squeezes out pinches an adjacent nerve root, it can result in significant pain known as sciatica in the leg or radiculopathy in the arm. The pain can be burning, almost like an electrical sensation. It can result in numbness or a pins and needles sensation.
It may result in motor weakness as well, such as biceps weakness or a foot drop. The area of pain, numbness or weakness depends on the specific nerve being pinched.
How do they occur?
As mentioned, disc degeneration may result in tears in the outer part of the disc. The outer part of the disc does have a nerve supply, so it may be painful.
But at any rate, if the tear in the disc is large enough, the inner part may squeeze out. This creates a herniated disc.
What treatments are available?
Just because a disc herniation exists, does not mean it needs treatment. Only if symptoms are present is treatment needed. For pain, treatment may consist of pain medication, muscle relaxers, anti-inflammatories.
In addition to medication, chiropractic and physical therapy treatment may relieve symptoms of nerve root compression. Also, spinal decompression therapy may relieve sciatica or radiculopathy.
Epidural injections with cortisone have been shown to relieve symptoms in over 75% of cases. A series of injections may be necessary over a six week period, which can be repeated every few months.
What are the outcomes for the condition?
By and large most individuals with a herniated disc are able to avoid surgery. Less than 5% of patients end up needing surgery. If muscle weakness is progressive or conservative treatment fails for 6 to 8 weeks, then surgery is indicated.
A landmark study in the Journal of American Medical Association looked at outcomes in patients with and without surgery for symptomatic herniated discs. At the one year point, outcomes were the same.
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