A Herniated Disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer "jelly" pushes out through a crack in the tougherexterior.Typically, this condition occurs when a tear in the tough, outermost layer of the disc (the annulus fibrosus) allows the soft, jellylike material within the disc (the nucleus pulposus) to bulge through the external wall of the disc.
A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don't need surgery to correct the problem.
People can develop Disc Herniations without symptoms; however, when the inner ring protrudes closely enough to a spinal nerve—a network of which run roughly parallel to the spine—this can result in significant amounts of pain. The pain is also often constant (chronic) because the source of the pain does not differ, as the Disc Herniation presses against, or in close proximity to, the nerve all the time. Disc Herniation syndrome is most often associated with the cervical (neck) vertebrae, or those in the lumbar (lower back) region, causing pain in these areas.
Causes of Disc Herniation
As an individual grows older, intervertebral discs gradually lose their water content. This reduces their flexibility and capacity to absorb shock. Gradual loss of fluid may also predispose the discs to tears, which may cause disc herniations. Gradual, age-related deterioration of the spinal discs is called degenerative disc disease (DDD). Although DDD may occur anywhere in the spine, it commonly affects the low back and the neck, which are common sites of disc herniation.
In addition, disc herniations occur more frequently in people who bear weight, which may increase intradiscal pressure. Other risk factors for disc herniation may include high body mass index (BMI), smoking, and atherosclerosis. For example, a study of 344 people who had an MRI and completed low back pain questionnaires at the age of 40 and again at 44 years found that disc-related MRI findings including disc herniations were concurrent with certain lifestyle factors (e.g., high physical work, high BMI, and heavy smoking). In the case of atherosclerosis, insufficient blood supply to the disc has been proposed to play a role as causative factor in disc herniation. A study supporting this assumption found an association between high cholesterol and triglyceride levels and symptomatic disc herniation.
Tears in the annulus fibrosus may cause severe pain due to release of inflammatory chemical mediators. Pain may also arise when these tears permit nerves on the periphery of the disc to grow into the disc and become painful. Disc herniation may also cause pain when bulging disc material compresses adjacent structures such as the spinal cord and nerve roots.
In addition to pain, individuals with herniated discs may experience numbness, burning, and tingling. These symptoms are likewise due to nerve irritation. Some individuals may develop sciatica, a condition involving shooting pain, numbness, burning, or tingling along the nerve that runs down the back of the leg.
Conversely, some people with disc herniation may experience no symptoms. Generally, in asymptomatic cases of herniated disc the extruded nucleus pulposus does not compress surrounding structures.
Treatments of Disc Herniation
Most disc herniations heal by themselves within a few weeks. However, a range of interventions are recommended to individuals whose disc herniations are painful. In general, pain management in disc herniation relies initially on conservative care, with more invasive procedures reserved as a last resort.
Common interventions for herniated disc may include administration of drugs that reduce inflammation, such as non-steroidal Anti-inflammatory drugs (NSAIDs), physical therapy, epidural steroid injections (injection of a steroid into the epidural space of the spinal cord surrounding irritated nerve roots, reducing inflammation and irritation), and Percutaneous discectomy (suctioning material out of a bulging disc, relieving pressure within the disc) When more conservative measures fail, surgery may be considered as a last resort. Typically, surgical procedures are recommended in serious cases involving severe, symptomatic compression of the spinal cord and nerve roots.
Intervertebral discs deteriorate with time, from the nucleus pulposus outwards. Age-related deterioration can be accelerated by physical disruption, which can lead to disc herniation. Disc herniations can cause significant pain. In general, research indicates a healthy lifestyle that promotes acceptable BMI, cardiovascular well-being, safe lifting of weight, and avoidance of smoking can help lower the risk of disc herniation and other forms of disc degeneration.
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Pain caused by disc herniation can be debilitating over time, so it is important to discuss your symptoms with your pain specialist. Your doctor can work with you on specific treatments and therapies that can reduce your pain and provide a more normal quality of life.