Herniated Disc (Slipped Disc)
The spine is made up of small bones known as vertebrae that are stacked on top of one another, extending from the base of your skull to your buttocks. In between the bones sits a soft rubbery cushion with a tough, outer layer (annulus) that surrounds the nucleus called a disc. These discs act as shock absorbers for the spinal bones.
A herniated disc, also known as a slipped disc, occurs when the disc nucleus is pushed out of the annulus due to a tear or rupture. As there is limited space in the spinal canal, this results in added pressure on the spinal cord or surrounding nerve root, producing pain that may be severe.
Herniated discs can occur in any part of the spine, more commonly in the lower back (lumbar spine). The area in which pain is experienced depends on what part of the spine is affected. A herniated disc often occurs with lifting or twisting movements.
WHAT ARE THE SYMPTOMS?
Most herniated discs occur in the lower back but can occur in any part of the spine. Depending on where the herniated disc is situated and whether the disc is pressing on a nerve, symptoms vary.
Common symptoms of a herniated disc include:
- Pain and numbness that is mostly on one side of the body
- Arm or leg pain
If the herniated disc is located in your lower back, most pain will be present in your buttocks, calf and thigh. If the herniated disc is located in your neck, most pain will be present in your shoulder and arm.
- Worsening pain at night or with certain movements
- Worsening pain after standing or sitting
- Pain when walking short distances
- Muscle weakness and aching in the affected area
WHAT ARE THE CAUSES AND RISK FACTORS?
Aging and wear-and-tear (degeneration) is one main cause of disc herniation. As we grow older, the flexibility of the discs reduce and are more prone to tears or ruptures.
Other causes and risk factors include:
- Twisting and lifting movements
- Being overweight
- Occupation (people who are involved in heavy lifting and physically demanding jobs have a higher risk)
WHAT IS THE DIAGNOSIS?
A history of the injury and a physical examination of the back will be conducted by the Doctor. He will check for any area of pain, and examine your nerve function and muscle strength.
Imaging tests will be taken, such as a x-ray, CT scan and MRI scan to confirm the area of herniated discs.
WHAT ARE THE COMPLICATIONS OF A HERNIATED DISC IF LEFT UNTREATED?
If a herniated disc is left untreated, this can lead to permanent nerve damage. A herniated disc can also cut off nerve impulses in extreme cases to the cauda equina nerves in your lower back and legs, which can result in a loss of bowel or bladder control.
Another long-term complication is saddle anesthesia. The herniated disc presses on the nerves, causing a loss in sensation in your inner thighs, the back of your legs, and around your rectum.
WHAT ARE THE TREATMENT OPTIONS?
Depending on the location of the herniated disc and how far the disc has slipped out, treatment options vary.
Nonsurgical treatments include:
- Over-the-counter pain relievers such as acetaminophen
- Muscle relaxers to reduce muscle spasms
- Physiotherapy to strengthen your back and restore your range of motion
Should nonsurgical methods fail to alleviate your symptoms caused by your herniated disc and it is affecting your muscle function, surgery may be recommended.
One surgical treatment is microdiscectomy, where part of the disc that is damaged or protruding out will be removed. In certain cases, your whole disc will be removed and replaced with an artificial disc and your vertebrae will be fused together.