Disc Herniation (Intervertebral Disc Hernia)

An intervertebral disc herniation or disc herniation is the most common cause of pain in both the upper and lower limbs.

In recent years, its appearance has become more and more frequent, as a consequence of the modern lifestyle, which is characterized by a lack of physical exercise and a sedentary lifestyle, as well as increased body weight due to poor diet.

Between the vertebrae (the bones of the spine) there are some “cushions”, which are called intervertebral discs or simply discs.

Their casing is hard, but their content is gelatinous, thanks to which they act as a… “shock absorber” of the spine, allowing at the same time, small movements that give us flexibility / elasticity.

An intervertebral disc herniation or simply a herniated disc is a condition in which part of the internal contents of the disc “slips” into the spinal canal resulting in pressure or even the complete entrapment of one or more nerves (roots).

In most cases, a herniated disc is due to the gradual wear and tear of the discs due to aging, which we call degenerative disease or simply degeneration. As we age, the discs lose some of their liquid content, become less elastic and therefore prone to injury. This degeneration occurs in others earlier and in others later in life. The mechanisms that determine the rate of degeneration remain largely unknown, but it is speculated that they are linked to a combination of genetic and mechanical factors.

In most patients, the problem begins with a minor injury and usually with the incorrect use of muscle groups when lifting a weight. Less often it can come from a fall or direct injury to the spine. In the neck, a herniated disc can result from a car accident.

In general, a herniated disc is a benign condition. However, in extreme cases it can cause permanent neurological damage with partial paralysis and loss of control of urination and defecation.

In particular, in the neck it can cause damage to the spinal cord with disorders of gait, balance and general coordination of movements.

There are three main factors for the occurrence of an intervertebral disc hernia:

• Body Weight:As our body weight increases, the mechanical stress on the discs increases, and in fact it affects much more the discs in the lower part (lumbar) of our spine.
• Occupation:Occupations that require physical work such as lifting, pushing or pulling heavy objects, frequent and prolonged twisting and bending of the waist, carry a greater risk of developing a herniated disc. Also, an increased frequency has been observed in professions, in which the spine is subjected to constant stress and minor injuries, such as drivers, pilots and flight attendants.
• Heredity:Scientists agree on the existence of a genetic mechanism that makes some individuals susceptible to the condition. Unfortunately, however, it has not yet been revealed.

There are three main factors that rule out the possibility of developing an intervertebral disc herniation:

• Exercise:Strengthening the muscles of the waist stabilizes and supports the spine, unloading the discs.
• Correct posture:Proper posture reduces pressure on the discs. We should keep our waist straight, especially when sitting for a long time, and use our legs rather than our waists to lift weights.
• Healthy body weight: Excess weight puts pressure on the spine and discs, increasing the likelihood of a herniation.

A serious but rare complication is Cauda equina syndrome (CES), in which the herniated disc compresses the nerves of the cauda equina (a nerve complex that is a continuation of the spinal cord). It is a serious neurological condition that causes partial or total loss of mobility of the lower limbs and is one of the most urgent situations in Spine Surgery.

Seek medical help immediately if you have:

• Worsening of symptoms.Pain, numbness, or weakness increase to the extent that you are unable to perform your usual daily activities.
• Bladder or bowel dysfunction.People who have horse riding syndrome may have incontinence or difficulty urinating even with a full bladder.
• “Saddle” anesthesia.This progressive loss of sensation affects the areas of the body that would be touched by a saddle, namely the inner thighs, the back of the legs, and the area around the rectum.

A herniated disc can irritate nearby nerves and cause pain, numbness, or weakness in one limb.

In most cases of herniated discs, clinical examination and medical history are all that is needed to make a diagnosis.

However, if your doctor suspects another condition or needs to see which nerves are affected, then depending on the case, X-rays, CT/MRI, myelograms, electromyograms may be requested.

The treatment of intervertebral disc herniation depends on the stage of the disease and its symptoms. If the symptoms allow it, then it is preferable for the patient to start with conservative treatment. However, when there are severe neurological symptoms, then surgical rehabilitation of the problem is the only way.

Conservative treatment is done mainly by avoiding painful postures and following a program of exercise and taking painkillers. It relieves symptoms in most people within a few days or weeks.

But if the pain has not been treated within a few weeks, then physical therapy is indicated. Physical therapists can show you postures and exercises designed to minimize the pain of a herniated disc.

If conservative treatments do not improve the symptoms of a herniated disc after weeks, then surgery is recommended, especially if the patient is dealing with:

• Numbness or weakness,
• Difficulty standing or walking,
• Loss of control of urination and defecation

A very small number of people with a herniated disc eventually need surgery. In several cases, surgeons remove only that part of the disc that protrudes and is causing the problem.

Rarely, however, a total removal of the disc may be required. In these cases, the vertebrae may need to be fused together with metal material to ensure stability in the spine.

Are there alternative treatments for herniated discs?

Some alternative and complementary therapies can help prevent chronic herniated disc pain, including:

Chiropractic. Chiropractic in the spine has been found to slightly relieve low back pain that lasted at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.

Acupuncture. Although the results are usually moderate, acupuncture seems to relieve chronic back and neck pain quite well.

Massage. This practical treatment can provide short-term relief to people who have chronic low back pain.

Yoga. A combination of physical exercise, breathing exercises, and meditation, yoga can improve spinal function and relieve chronic back pain.