What is Intervertebral Disc Herniation?
Intervertebral disc herniation is the displacement of the cushion or disc that is situated between the vertebral bones. Intervertebral discs are the soft pad like cushioning between each vertebrae that acts as a shock absorber for the spine and all of its different parts.(1)
When displacement or herniation of the disc occurs, the disc ruptures or bulges out between the vertebrae and begins to pinch the nerves in the spine and the spinal cord. The herniated intervertebral disc can impinge upon the spinal cord or nerve roots causing pain and dysfunction of the nervous system.
Types of Intervertebral Disc Herniation
The type of Intervertebral disc herniation depends on the location of the herniation. Intervertebral disc herniation may occur in the lumbar spine, cervical spine, and thoracic spine.
Intervertebral Disc Herniation of Lumbar Spine
Intervertebral disc herniation of lumbar spine is a common cause of low back pain, buttock pain, and leg pain and can occur between any the vertebrae L1 to L5 of low back.
Symptoms of Intervertebral Disc Herniation of Lumbar Spine:
- Tingling or numbness in one leg.
- Weakness in certain muscles and in one or both legs.
- Movements or activities such as bending, coughing, or sneezing may intensify the pain caused due to the lumbar spine intervertebral disc herniation.
- Leg weakness or loss of leg function.
- Muscle spasms or cramping.
Intervertebral Disc Herniation of Thoracic Spine
Intervertebral disc herniation of thoracic spine causes mid back and rib pain or abdominal pain. It is located in the upper back. Intervertebral disc herniation of thoracic spine is not as common as intervertebral disc herniation of lumbar spine or cervical spine. Thoracic Intervertebral disc herniation can happen anywhere between the T1-T12 vertebrae in the mid back region.
Symptoms of Intervertebral Disc Herniation of Thoracic Spine:
There are 3 areas where disc herniation can take place and they are central, lateral, or centro-lateral. The symptoms for each are as follows:
- Central Disc Protrusion. When there is pressure from the thoracic herniated disc, pressure is put on the spinal cord which affects the nerve. This leads to upper back pain. Size of the herniated disc and the amount of the pressure on the spinal cord determines the extent of the symptoms.
- Herniated Lateral Disc. Protrusion of disc laterally. The gel-like material will put pressure on the nerve that is located at that level of the spine and will likely cause radiation chest wall or abdominal pain.
- Herniated Centro-lateral Disc. Usual symptoms associated with this type of herniation are upper back pain, radiating pain, or myelopathy, which is a functional disturbance or pathological change in the spinal cord.
Intervertebral Disc Herniation of Cervical Spine
A Intervertebral disc herniation of cervical spine is a common cause of neck and arm/shoulder pain.
Symptoms of Intervertebral Disc Herniation of Cervical Spine:
- Numbness, tingling, and/or burning in the arm on the affected side is a common symptom of thoracic intervertebral disc herniation.
- Movement or activities like as bending, coughing, or sneezing may cause worsening of the pain. Head movement to any one side may also aggravate the patient’s symptoms.
- Arm weakness or loss of arm function.
Tests to Diagnose Intervertebral Disc Herniation
To diagnose intervertebral disc herniation, a physical exam by a specialist and a diagnostic study like an MRI or x-ray will be required to determine if it is a normal wear and tear of the disk or if there is something else causing the problem.
Treatments for Intervertebral Disc Herniation
Intervertebral disc herniation can be successfully treated with medications, physical therapy, and steroid injections performed by a pain management specialist. If these treatments are not effective for relieving the symptoms of intervertebral disc herniation, then surgery could be an option. Some intervertebral disc herniation can be treated with minimally invasive surgery like lumbar microdiscectomy, endoscope assisted discectomy, cervical “keyhole” foraminotomy with discectomy, while others require traditional open surgical techniques like anterior cervical discectomy with microscope assistance and fusion.
To treat Intervertebral disc herniation, doctors will often try non-surgical methods before considering surgery and these include:
- Alternating between cold and warm compresses, preferably using ice.
- Non Steroidal Anti-inflammatories, corticosteroids, neuropathic pain meds does help.
- Muscles Relaxants like Soma and Skelaxin.
- Spinal Manipulation or Traction by a Chiropractor.
- TENS-Transcutaneous Electrical Nerve Stimulation.
- Massage Therapy.
Prevention for Intervertebral Disc Herniation
Staying physically fit to reduce the load on the spine and keeping the back and stomach muscles equally strong can reduce the chances of back pain caused due to intervertebral disc herniations.
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