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Texas Orthopedics, Sports & Rehabilitation Associates

Herniated Disc - Pain Management 

Introduction

A herniated disc, also called a “ruptured” disc, is a common source of neck or lower back pain.  Discs are cushion-like pads that are located between the series of small bones that make up the spine.  A herniated disc occurs when the outer disc layer tears and it’s gel-like interior comes out.  The contents can irritate nerves.  A herniated disc can cause pressure on the nerves or spinal cord.  Fortunately, for the vast majority of people, pain related to a herniated disc can be relieved without surgery.

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Anatomy
The spine is made up of a series of small bones called vertebrae.  The different areas of the spine are defined by their curvature and function.  The cervical spine is located in the neck, the thoracic spine is in the chest, and the lumbar spine is in the lower back.  Herniated discs occur most frequently in the cervical and lumbar spine.

The opening in the center of each vertebra forms the spinal canal.  Your spinal cord is inside of the protective spinal canal.  Nerves extending from the spinal cord exit the spine and travel throughout your body, sending messages between your body and brain.

Intervertebral discs are located between the vertebrae.  A disc and two facet joints connect one vertebra to the next, allow movement, and provide stability.  The discs are made of strong connective tissue.  Their tough outer layer is called the annulus fibrosis and their gel-like center is called the nucleus pulposus.  A healthy disc contains about 80% water, which allows it to act as a shock-absorbing cushion between the bones.  

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Causes
With age, the discs lose water content.  The discs become narrower, less flexible, and less effective as cushions between the vertebrae.  As a disc deteriorates, the annulus fibrosis (outer layer) can tear or rupture.  A herniated disc results when the nucleus pulposus (inner contents) come out of the disc. 

In addition to the natural aging process, herniated discs can result after sudden pressure.  Impacts from trauma, violence, and motor-vehicle crashes can cause a herniated disc. Abrupt forces during sports, such as football or surfing, can cause a herniated disc, as well.
 
If the nucleus pulposus extends into the spinal canal, it can cause pressure on the spinal cord and spinal nerves.  When the inner contents come in contact with the spinal nerves, a chemical reaction occurs.  The spinal nerves become irritated and inflamed, resulting in pain. 

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Symptoms
The type of symptoms that you experience depends on the location of the herniated disc in your spine.  Herniated discs most frequently occur in the cervical (neck) and lumbar (lower back) spine.  Pain is a major symptom of a herniated disc, regardless of its location.

Neck pain is a common symptom of a herniated cervical disc.  You may feel shooting pain in your arms.  You may experience pain or burning pain in your shoulders, neck, and arms.  Your arm(s) may feel weak, numb, or have a tingling sensation.  You may experience a headache at the back part of your head. 

Low back pain is a symptom of a herniated disc in the lumbar spine.  Sciatica is the most frequent symptom of a herniated disc in the lower back.  Sciatica is shooting pain that travels through the buttocks and down the back of one leg.  One of your legs or buttocks may feel weak, numb, or have a tingling sensation. 
 
In rare cases, the loss of bowel and bladder control along with significant arm and leg weakness indicates a serious problem.  In this rare case, you should seek emergency medical attention.  Call 911 or go to the nearest emergency department of a hospital.

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Diagnosis
Your doctor can diagnose a degenerative disc by performing a physical examination and some tests.  You will be asked about your symptoms and medical history.  Muscle strength, joint motion, and stability will be tested.  Because the nerves from the spine travel to the body, your doctor will perform a neurological examination of your arms and legs to see how the nerves are functioning.

Your doctor will order X-rays to see the condition of the vertebrae in your spine.  Dye may be used to enhance the X-ray procedures in a procedure called a myelogram.  A myelogram is used to help determine if there is pressure on your spinal cord or nerves from a herniated disc.
 
Additional imaging tests, such as a computed tomography (CT) scan, discogram, or magnetic resonance imaging (MRI) scans may be ordered.  A discogram is another type of imaging test that provides a view of the internal structure of a disc to help identify if it is a source of pain.  A discogram is usually immediately followed by a CT scan to show more detail about the extent of the rupture or tear pattern, as well as the size and shape of the disc.  The MRI scan is the most sensitive imaging tool.  The MRI provides the most detailed images of the discs, ligaments, spinal cord, and nerve roots. 
 
In some cases, a nerve conduction velocity (NCV) test is used to measure how well the spinal nerves work.  During the NCV test, a nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured.  Before the NCV test begins, sticky patches with electrodes will be placed on your skin that covers the spinal nerve that is being evaluated.  The NCV may feel uncomfortable, but only during the time that the test is conducted. 

An electromyography (EMG) test is often performed at the same time as the NCV test.  An EMG measures the nerve impulses within a muscle.  Healthy muscles need nerve impulses to perform movements.  Your doctor will place fine needles into the select muscles that a spinal nerve controls.  The EMG allows your doctor to determine the amount of nerve impulses that are conducted when your muscle contracts.  An EMG may be uncomfortable, and your muscles may remain a bit sore following the test.

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Treatment
The vast majority of people with herniated discs are successfully treated with non-surgical pain management treatments aimed at relieving pain and restoring function.  Over-the-counter medication or prescription medication may be used to ease your pain.  If your symptoms do not improve significantly with these medications, your doctor may inject your spine with corticosteroid medication to relieve pain at the source of the problem.

A short period of rest may be recommended.  Your doctor may initially restrict your activity level and body positioning.  You should avoid lifting, bending forwards, and quick abrupt movements.  You may wear a back or neck brace for support.  It can help to take brief walks and avoid sitting for prolonged periods.
 
Your activity level will gradually be increased by your doctor.  You may be referred to physical therapy.  Occupational or physical therapists can provide treatments to help reduce your pain, muscle spasms, and swelling.  The therapists will teach you exercises to help strengthen your neck muscles or back and abdominal muscles.
 
Non-surgical pain management treatments for herniated disc are designed to relieve pain and restore function, but they cannot correct structural abnormalities in a disc or the spine.  For some people, surgery may be recommended if non-surgical treatments do not provide relief, if there is pressure on a nerve, and if there is considerable loss of function.  An anterior cervical diskectomy and fusion (ACDF) is a common surgery for a herniated disc in the cervical spine.  A microdiskectomy or laminectomy are surgeries used to treat a herniated disc in the lumbar spine.

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Am I at Risk

Herniated discs are more common among people that are middle-aged.  Older adults are at the greatest risk for herniated discs because of the decreased disc water content. 

Risk factors for herniated disc include:
• Being overweight
• Smoking
• Using poor body posture when lifting
• Performing repetitive strenuous activities

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.