Disc Herniation: A Complete Guide
Jul 27, 2020 by Dr. Ahmad Elakil
Disc herniation is a grave bodily ailment that can compromise your mobility and requires comprehensive treatment, often leading to surgery. It is important to note that the discs are pads that provide cushioning support to the vertebral bodies and reduce the impact of physical exertion on movement on the spinal column.
The design of a disc is similar to that of a jelly donut. It features a soft component in the center, known as the nucleus pulposus. Any injury or damages that abnormally rupture the nucleus pulposus lead to disc herniation. Typically, a herniated disc commonly occurs in the disc located between the fourth and fifth lumbar vertebrae in the lower back.
If the disc herniation is sufficiently large, the disc tissues can exert pressure on the nearby spinal nerves, which can aggravate the health of the spine. A herniated disc is treated through various treatment courses, and the diagnosis involves physical examinations, electrical, and imaging tests.
The treatment depends entirely on the intensity of the symptoms, and it typically includes physical therapy, pain-relief medications, muscle-relaxant drugs, anti-inflammation medicines, epidural, and cortisone injections. In case of severe symptoms and increased threat of aggravated damages, doctors look into surgical operations to restore the health of the spine.
Reading all of this can sound overwhelming, but don't worry. My comprehensive guide will walk you through the causes and symptoms of disc herniation and explore some of the ideal treatment routes and surgical operations.
Here's everything you need to know:
Understanding the Design of the Spine
As a spine surgeon, I believe that in order to understand the complexities of disc herniation, it is crucial to understand how the spine and its discs are designed. The spine is made of bony building blocks, known as the vertebrae, and the discs provide support and mobility to the larger vertebrae. Ligaments surround the spine and discs.
There are seven vertebrae in the neck, known as the cervical vertebrae, 12 are located in the mid-back, known as the thoracic vertebrae, and five vertebrae are located in the lower back, known as the lumbar vertebrae. The sacrum is tucked beneath the fifth lumbar vertebrae in the mid-buttock region, adjacent to the tailbone, also known as the coccyx.
The human spine is designed in a manner that allows the vertebrae to be stacked together to create a movable structure, provide ample support, and protect the spinal cord. The spinal cord comprises of sensitive nervous tissues, which connect the spinal column to the brain.
The vertebrae protect the spinal cord from injuries. Each vertebra boasts a spinous process, which is a bony presence to protect the nerve tissues in the spinal cord. The vertebrae also boost a sturdy skeletal form that provides the spinal cord from the front and allows greater flexibility and protection for bearing weight.
The discs are cushiony pads that provide support and minimize the impact of physical exertion to protect the spinal column and enhance flexibility. Ligaments are study fibrous tissues that serve the function of attaching the bones firmly together. They attach all the vertebrae and are placed alongside all of the discs. As the disc begins to degenerate, the ligaments get injured, resulting in pain in the affected area.
Now that I have explained the structure of the spine let's take a closer look at disc herniation and how it occurs.
What is a Disc Herniation?
As I explained above, the design of the disc is very fragile and very similar to that of a jelly donut. As the body continues to age, the disc degenerates, and this degeneration can also occur due to a back injury. The nucleus pulposus, the soft part in the center of the disc, can herniate or get ruptured from the annulus fibrosus, which is the outer ring that surrounds the disc.
Disc herniation refers to the abnormal rupturing of the nucleus pulposus, and it is more commonly known as a slipped disc. A herniated disc typically occurs in the disc located between the fourth and fifth lumbar vertebrae, tucked within the lower back. You see, the lower back is constantly exposed to the impact of lifting the weight of the upper body.
The lower back vertebrae and discs play a crucial role in supporting our bodies while sitting or standing. More importantly, the lower back is heavily involved in supporting various movements as we go about our daily chores. The lumbar vertebrae and discs are involved in twisting the torso, side-to-side rotations, and in allowing flexion and extension every time we bend and lift something off the ground.
The risk factors of a herniated disc typically include heavy lifting, spine degeneration, excessively bending the spine, or a spinal injury. This condition can be prevented by taking care of spinal health, preventing serious injuries, and avoiding heavy lifting.
What are the Symptoms?
The symptoms of a disc herniation vary, depending on the exact condition and severity of the rupture. The symptoms depend on the factors listed below:
- The condition of the spine.
- The exact location where the herniated disc has occurred.
- Whether or not there has been any damages or irritation to the nerve tissues.
In some instances, a disc herniation might not even manifest any symptoms. However, it can cause pain in the spinal area that has been affected.
A more massive disc herniation can cause the disc tissue to press against the nearby spinal nerves located in the affected area that connect the spine and the brain. This can give birth to terrible pain in the network of that nerve, and it typically occurs on one side of the body. This shooting nerve pain is known as sciatica pain.
For instance, if the disc herniation occurs between the fourth and fifth lumbar vertebrae of the lower back, it can give rise to sciatica pain that travels down the buttock and impacts the back of the leg and calves.
If the disc herniation takes place in the cervical spine, it can cause the pain to travel down one arm, and cause muscle spasms and stiffness in the neck. In case of a massive disc herniation, the disc tissue can press against spinal nerves located on both sides of the body. This can give rise to intense pain on one side or both sides of the body. It also leads to severe muscular fatigue in the lower body, and in some cases, patients also inexperience bladder and bowel incontinence. Medically, this condition is known as the cauda equina syndrome.
Diagnosing a Herniated Disc
If you consult a professional on any of the symptoms mentioned above, as a spine surgeon, I strongly believe that the doctor is likely to suspect a case of disc herniation. However, a detailed neurological exam will be required to substantiate the symptoms and understand the abnormal reflexes at work in the spine.
In many cases, I conduct the positive straight leg raising test, which provokes pain by raising a straight leg while sitting or lying. Patients report if they feel any unusual sensations in their leg or foot. I also require various blood tests to identify potential signs of infections or inflammation in the spinal structure.
X-rays are conducted to identify signs of degeneration within the spine; however, none of these methods can reveal the exact condition of the discs. An MRI scan or CT scan is conducted to identify whether the disc is herniated or not. In some cases, I prescribe a CT myelogram to further understand the structures that have been impacted by a disc herniation.
A CT myelogram is a type of CT that is conducted after injecting contrast dye into the spinal canal. It enhances the visualization of the discs and provides a comprehensive picture of the spinal structures that have been affected. I typically rely on an electromyogram (EMG) to precisely identify the nerves that have been irritated.
Treating a Disc Herniation
A disc herniation can exert pressure and cause irritability in the nerves within the spine, which gives birth to shooting pain, fatigue, and exhaustion. It can also cause numbness in the arms, leg, and neck, alongside low back pain. In many cases, these symptoms can drastically decrease life quality and disrupt one's lifestyle.
However, in most cases, the symptoms of a herniated disc begin to alleviate gradually on their own. The course of the treatment also varies depending on the severity and intensity of the symptoms.
Here are some of the most common treatments for disc herniation:
1. Resting the Spine
I, Dr. Ahmad Elakil, neurosurgeon in Lafayette, advise my patients to rest their spine for a few days. Patients must alter their routines and rest as much as they can. Resting can prove helpful in reducing the inflammation, and allowing the back ample time to heal. It is crucial to avoid exercising, heavy lifting, physical exertion, or any activity that involves bending when you are experiencing low back pain.
I typically advise bed rest for a brief period. However, it is also crucial to avoid staying in bed within no physical exertion for more than two days. It is essential to prevent stiffness to settle in your muscles and joints by moving around.
Many patients find relief from the excruciating pain by using ice packs and heat compresses. Just place a warm towel or ice pack against the affected area to eliminate the low back pain and soreness. Try both methods and then choose the one that is most effective for you.
I typically prescribe over-the-counter medicines to reduce the pain, such as Motrin, Advil, Naprosyn, or Aleve. These medicines aid in alleviating pain and reducing the swelling. However, it is crucial to avoid using these over-the-counter pain killers for more than ten days without consulting your doctor.
Spine surgeons, including myself, typically advise against administering large quantities of nonsteroidal anti-inflammatory drugs (NSAIDs) as they can put you at risk for heart complications and bleeding. If the over-the-counter medicines do not provide any relief, doctors prescribe narcotics, such as oxycodone-acetaminophen, or codeine. These are also short-term medications.
Patients who suffer from muscle spasms in the back are typically prescribed muscle relaxants. Those who suffer from nerve damage are prescribed nerve pain-relieving medications, such as duloxetine, pregabalin, amitriptyline, tramadol, and gabapentin.
Physical therapy is a significant component for healing low back pain, disc herniation, and any bodily injury because maintaining mobility is crucial to prevent joint and muscular stiffness. Many exercises prove effective at alleviating the symptoms of disc herniation, and a physical therapist can help you strengthen your back muscles and speed up the healing process.
Here are some physical therapy treatments that prove beneficial for disc herniation:
- Electric muscle stimulation
- Ice and heat therapy
- Aerobic exercises, like riding a stationary bicycle or walking
- Stretching moves to enhance muscular flexibility
- Regular full-body massages
- Ultrasound therapy
When the patient does not feel any improvements from the medications, physical therapy, and rest, I can prescribe steroid injections. These steroid injections, also known as epidural injections, are injected into the space surrounded by the spinal nerve.
The steroid medicine aids in reducing the inflammation, reduce the pain caused by disc herniation, and makes it easier to move around. I normally have to conduct a CT scan or an X-ray to identify the exact location where the steroid medicine has to be injected. Many patients require more than one epidural injection to alleviate their pain.
5. Spine Surgery
The majority of the patients suffering from disc herniation do not require a surgical procedure. I, Dr. Ahmad Elakil, a trusted Louisiana neurosurgeon , strongly believe that it is crucial to exhaust other treatments and bed rest for at least four to 6 weeks before turning towards surgery. If the pain does not improve during this period, surgery can be a more viable treatment.
When should you consider spine surgery for disc herniation?
Here are the conditions that prompt patients to consider surgery:
- Pain relievers, epidural injections, and physical therapy have failed to provide relief.
- Your symptoms continue to aggravate and worsen.
- You are unable to control your bowel movements or bladder.
- You face difficulty while standing or walking around.
A diskectomy is a procedure where a spine surgeon removes the damaged disk to alleviate the pressure exerted on the nerves. This surgery can be performed in various ways. For instance, I can perform an open discectomy by cutting into the patient's neck or back.
A microdiscectomy is performed with a comparatively smaller incision, and I normally insert a thin tube with a camera attached to one end to obtain a clear picture and remove the damaged disc.
7. Lumbar Laminotomy
In certain cases, as a spine surgeon, I may also have to remove a tiny piece of bone attached to the vertebra; this is known as the lamina. The lamina creates a protective shield over the spine and removing all of it, or a small part can aid the spine surgeon in reaching the herniated disk.
A lumbar laminotomy aids in alleviating the pressure on the nerves and can eliminating sciatica and leg pain. The lamina can also be removed during a diskectomy, but in some cases, I conduct a separate surgery to take it out.
8. Spinal Fusion
After conducting a laminotomy or diskectomy, I can fuse the two vertebrae on either side of the disk to add stability to your spinal structure. This process is known as spinal fusion. Once the surgeon combines the two disks, it will prevent the bones from moving, thereby eliminating the pain.
9. Artificial Disk Surgery
I, Dr. Ahmad Elakil, neurosurgeon in Lafayette, strongly believe that some young patients are ideal candidates for performing an artificial disk surgery. This is primarily because this surgical procedure is effective on certain disks located in the lower back area.
However, if, as your spine surgeon, I believe this is a viable treatment for you, I will replace the herniated disk with an artificial disc made of metal or plastic. The new disk will offer greater stability and support to the spine, making it easier to move around. It will also reduce low back pain and stiffness.
Treating a Cervical Herniated Disc
Cervical discs provide cushioning support to the cervical vertebrae, located in the upper back and neck. A cervical herniated disc occurs when the nucleus pulpous is either ruptured or herniated through the cervical disc's outer wall.
This condition is typically caused by excessive stress, heavy lifting, or damaging injuries. It can cause severe pain when the damaged disc begins to exert pressure on the nerve roots or spinal canal.
The symptoms typically include the following:
- Weakness in the arms or hands.
- Pain that travels down the arm to the hand or fingers.
- Numbness in the shoulder, arms, or hands.
- Tingling sensations in the shoulder, arms, or hands.
The pain can aggravate by adopting certain neck positions, altering posture, or simple neck movements. The symptoms of a cervical disc herniated are quite similar to other conditions, such as gout, carpal tunnel syndrome, or rotator cuff-related complications.
In certain cases, I have witnessed that a cervical herniated disc can cause the disc structure to exert pressure on the spinal cord; this is known as spinal cord compression. This is an aggressive condition, and I strongly recommend a pragmatic and proactive treatment, alongside early detection.
The symptoms of spinal cord compression include:
- Tingling sensations or shock-related feelings traveling down the upper body towards the legs.
- Awkwardness and stumbling while walking.
- Motor complications while moving the arms and hands.
Cervical disc herniation usually occurs in patients between patients aged 30-50, and I have also treated this condition in 80-year olds. However, this is a relatively rare disc herniation condition, as the aging process causes the disc to dry out, thereby preventing the risks of rupture.
Diagnosing a cervical disc herniation requires a detailed physical examination. As a spine surgeon, I will examine mobility limitations, balance issues, pain affected areas, lack of extremity reflexes, muscular fatigue, abnormal reflexes, and sensory loss. I will also conduct various tests, including X-rays, bone scans, CT scans, MRIs, and a CT myelogram.
The non-surgical treatment for a cervical herniated disc revolves around alleviating pain. Majority of the cases of arm pain caused by a cervical herniated disc get resolved within a few weeks or months. Medications can be used to reduce and eventually eliminate the pain, and once the pain improves, it takes a few weeks for the weakness, numbness, and tingling sensations to go away.
Here are the treatment options for cervical herniated disc:
- Physical therapy and exercises are essential to eliminate the pressure exerted on the nerve root.
- I typically prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the swelling and neck pain. Analgesics are also prescribed to counter the pain.
- Epidural steroid injections and nerve root injections are prescribed to alleviate swelling and acute pain that travels down to the hips and legs.
- If the pain of a cervical disc herniation lingers for more than 6-12 weeks and causes severe disability, spine surgery is a viable alternative. Spine surgery is a reliable treatment for cervical herniated disc, and it has minimal risk for unwanted side effects and postoperative pain.
- A spine surgeon is likely to perform an Anterior Cervical Discectomy and Fusion (ACDF) or a Cervical Spinal Fusion.
I, Dr. Ahmad Elakil, a renowned Louisiana neurosurgeon, believes that surgery carries a very low risk of failure or postoperative complications with an experienced spine surgeon. I have witnessed a high success rate and is highly beneficial at alleviating pain and restoring mobility, particularly for patients who are suffering from severe disability.
Can Disc Herniation Heal Naturally?
Patients often wonder if their herniated disc could heal on its own, and the symptoms can indeed begin to fade away gradually over time, without requiring medical interventions. However, if the pain and stiffness subside, it doesn't necessarily indicate that your herniated disc has healed naturally.
The symptoms can resolve over time, but the herniated disc remains ruptured and can cause complications at any time. As a spine surgeon, I believe that in order to understand how the symptoms of disc herniation can heal gradually on their own, it is crucial to know how the pain emerges.
Disc herniation can occur because of the rupturing of the annulus, which is the outer layer of the disc. Or, it can also occur due to damages to the endplate of the vertebral body, which causes the gel-like nucleus pulposus to ooze out of the disc. As the nucleus pulposus oozes out, it can compress or pinch areas of the nerve sac, which can trigger pain.
The nucleus pulpous is filled with inflammatory proteins, which give birth to inflammation within the sciatic ner root, located in the lower back, giving birth to the terribly agonizing sciatica pain.
Now, coming back to how a herniated disc can heal on its own or be an asymptomatic condition: three main processes can naturally alleviate the symptoms.
These processes include:
Immune response by the body can cause the body to identify the herniated portion of the disc, regard it as foreign material and attack it. This immune response allows the body to reduce the size of the herniated fragment naturally.
The absorption of water is another natural process that can heal the symptoms. You see, the herniated fragment of the disc contains water, and with time, this water gets absorbed by the body. As the water is absorbed, the herniated piece begins to shrink in size naturally.
Innate Disc Mechanisms
The natural mechanics of the disc can also promote healing and alleviate pain. Many experts believe that extension exercises allow the symptomatic part of the disc to be moved inward and away from the spinal nerves—this aids in eliminating the low back and neck pain.
These three natural processes can prove useful at reducing the pain and the irritation caused to the nerve roots. However, the disc will still remain herniated as these natural bodily responses cannot heal herniation. The symptoms tend to alleviate due to the size reduction of the herniated fragment, and the reduction of inflammation near the nerve root.
The symptoms of a herniated disc tend to vary from patient to patient, and managing the symptoms also plays an effective role in the overall healing process. Many MRI research studies have revealed that countless patients have a large disc herniation, and yet, they do not feel any pain whatsoever.
The ideal route is to identify treatments and rehabilitation therapies that can reduce acute pain and disabling symptoms to prevent future complications. If you are suffering recurrent symptoms due to disc herniation and heightened disability, you may have to consider surgical interventions.
As a patient, it is crucial to avoid being overly anxious about healing your herniated disc, mainly if your symptoms have been eliminated. The priority must be eliminating pain, and if you're not feeling any pain, you have nothing to worry about.
Protecting Your Spine
Protecting your spine and managing your symptoms is crucial. Even if your condition continues to improve with treatment or without any medical interventions, always remember that disc herniation can happen again.
Therefore, I, Dr. Ahmad Elakil, neurosurgeon in Lafayette, strongly advise my patients to protect their spine and prevent the risk factors of another disc herniation. It is essential to correct your posture and focus on sitting straight and standing upright. If your work requirements or home chores require constant standing for long periods, consider using a footrest, stool, or box to alleviate the pressure on your back.
It is crucial to avoid lifting heavy objects and bending too much. Squatting the knees to pick up heavy objects can also put the spine at risk of injuries. Bending from the waist can also put excessive pressure on the lower back and spine.
Maintaining a healthy weight is crucial for those suffering from low back pain or disc herniation, and the extra pounds can cause a strain on the back, making the spine vulnerable. I, Dr. Ahmad Elakil also advises my patients against smoking. It can harden the arteries, which can damage the discs located in the spine.
It is also essential to maintain a healthy regime of exercise and physical exertion. Instead of over-exerting yourself and aggravating the pain, consider exploring the benefits of muscle-relaxing stretches and yoga routines. Yoga has proven extremely beneficial for patients suffering from cervical disc herniation, but it is vital to consult an expert instead of experimenting at home.
Need a Louisiana Spine Surgery Specialist?
If you need to consult a spine surgeon in Louisiana, you've come to the right place.
I, Dr. Ahmad Elakil, feel proud to be one of the most trusted and well-respected neurosurgeons in Lafayette, and help my patients resolve low back pain, neck pain, back pain, spinal pain, and complications. I specialize in performing minimally invasive surgical procedures to help my patients enjoy speedy healing and a quick recovery.
I am focused on aiding patients with minimally invasive procedures that allow speedy recovery and do not accompany any postoperative complications.
If you think you are suffering from the symptoms of disc herniation, spinal pain, or painful sensations traveling down your back arms or legs, it is crucial to consult an expert immediately. Patients often neglect treatment and rely on over-the-counter medications to counter the pain and gain temporary relief.
I strongly advise against such remedies and abusing over-the-counter medications as they aggravate the condition and cause other health complications.
You can reach out and book your appointment at https://www.ahmadelakil.com or call 337-534-4996 .