Herniated disk is the herniation of inter vertebral disk present in between the vertebral disk. The herniated disk compresses the nerves coming out from the spinal cord and hence herniated disk results in back pain, leg pain, or weakness of the lower extremity muscles in the patients having herniated disc. Intervertebral disk is the cushion present between the vertebral bones. The herniated disk occurs when the cushion disk present between vertebrae pushed outside its normal position. A herniated disc may not be troublesome if the spinal nerves are not involved for compression of disks.
How the herniated disk occurs ?
The spinal disc or intervertebral disk is a soft, cartilaginous, cushion situated between each vertebrae of the spine and vertebral column.. The inter vertebral spinal disc becomes more rigid with age. The non herniated disk is soft and elastic in nature, but along with aging and other physiological changes,vertebral disc looses its elasticity gradually and becomes prone to injury. Now a days nearly thirty percent of adults are also suffering from herniated disk.
What happens with a ‘herniated disc’?
In case of herniated disk, the rupture of spinal disk occurs and the disk also loses elastsicity. When spinal disc get ruptured, a portion of spinal disc pushes outside its normal position and this is termed as herniated disc. When the herniated disc bulges out in between the vertebrae, the spinal nerves and spinal cord will be compressed and it leads to neural insufficiency in the body manifested by severe pain in legs, etc, where the herniated disk affected nerve supplies in body.
Causes of herniated disc
A sudden fall or an accident can cause herniated,
In some women herniated disk occurs gradually, due to repetitive straining of spinal disk.
Patients with spinal stenosis are prone to have herniated disk, because the spinal space becomes narrowed in case of spinal stenosis.
When a herniated disc compresses the nerves root and results in irritation of nerve.
Symptoms of a herniated disc
Because of herniated disk, spinal cord or spinal nerves become compressed. The area which is supplied by these affected nerves become painful, less sensational, etc amd the symptoms of herniated disk manifests. The body parts supplied by these herniated diak affected nerves, becomes less functional. Abnormal signs of herniated disk are appeared because of compressed nerves at the point of herniated disk.
Common symptoms of a herniated disc include:
• Severe pain : The compressed nerve root because of herniated disk results in severe pain which is similar to electric shock pains. When the compression of nerves in the cervical region, the shocks moves down the arms, and the compression of nerve root in the lumbar (low back vertebrae) region, the abnormal sensation occurs in lower legs.
• Tingling and numbness in affected nerve area : Abnormal sensations like tingling, numbness, occurs in the area where that the herniated disk affects. These symptoms of herniated disk are very painful and makes an individual unable to do the daily living activities.
• Weakness of Muscles : muscle weakness occurs because of poor nerve supply to the area. Nerve irritation occurs because of poor signal supply to the muscles from brain.This causes muscle weakness in herniated disk patients. Nerve irritation can be identified easily by examining neural reflexes.
• Bowel or Bladder Problems
These symptoms of herniated disk are because of cauda equina syndrome, is the common problem resulting from herniated disc. Cauda equina syndrome is the medical emergency and immediate medical treatment is needed to restore the normal bowel and bladder functions.
• Back pain radiates to the buttocks and legs in case of herniated disk in lumbar region or lower back
• Neck pain that radiates to the shoulders and upper arms, when disk herniation occurs in upper back
• Tingling or numbness where the nerve supply got affected because of nerve compression.
• Muscle spasms or weakness due to poor supply of nerve impulse from the brain.
• Sciatica : is the pain occurs through the path of affected nerve supply in buttocks and legs.
The compressed nerves doesn’t supply the determined nerve impulses to the particular area in the body and it leads to nerve irritation and poor nerve sensation in the area where these nerves supplies. The symptoms of herniated disk are very irritable and the persons affected with herniated disk suffers lot and becomes unable to lead the normal daily living activities.
Diagnosis of a herniated disc
Physical examination : Physical examination is the common diagnostic test done to find herniated disk. Physical examination by the physician includes analysis of sensation, muscle strength, and nerve reflexes.These physical examinations and the history obtained from the patient helps lot to diagnose herniated disc.
MRI scan is the very important and clear means of diagnosis for herniated disk,and is commonly used by most of orthopedists for diagnosis of the herniated disc. Ct scan, blood test X -ray and some other tests are also associated with MRI scan to diagnose herniated disk.MRI scan is very helpful to identify the extent and nature of herniated disk at the region of lumbar vertebrae.
Proper diagnosis of herniated disc is important to treat the problem and make the patient to feel better. Symptoms experienced by the herniated disk patients, physical examination findings, x-ray findings, and MRI results together helps in diagnosing herniated disk.
Treatment of herniated disk
Treatment of a herniated disc is dependable on
• Symptoms experienced by herniated disk patient
• Age of the patient
• Severity of disease in patient
• Extent of inability and neural irritation in patients.
Conservative treatment is the main and important treatments given for herniated disc patients in the beginning. The treatment for herniated disk includes
Rest & Activity: Complete bed rest should be given to the patient with herniated disk, by stopping all the activities of the patients. If the patient continues to do the daily living activities and other small works in the home, it aggravate the symptoms of herniated disk. Most of disc herniation will resolve within weeks to month. Activities should be done as per doctor’s advice and mild activities can be done after the pain subsides. Application of traction is most beneficial in herniated disk patients.
Heat and Ice applications : Ice and heat application to the site of disc herniation is very helpful in relieving the symptoms of a disc herniation such as pain, irritable and burning sensation, etc.The heat or cold application to the disc herniated site helps in relaxation of muscles of the back, and specially beneficial in lumber disk slip or bulging disk. Ice and heat applications are good treatment options to relieve muscle spasm and for effective pain relief.
Physiotherapy : Physiotherapy and lumbar stabilization exercises are also the treatment given for herniated disc. Physiotherapy helps in enhancing nerve supply to the area and relieves muscle spasm by relaxing the muscles. Lumbar stabilizing exercises stabilizes lumbar spine muscles in disc herniation patients. The patients who not go for herniated disc surgery, these treatments are more beneficial. Physiotherapy helps in stabilizing vertebrae, makes muscles stronger. This reduces the symptoms of herniated disk.
Anti inflammatory Drugs
Non steroidal anti-inflammatory medications (NSAIDs) are given to relieve the pain because of disc herniation. The mechanism of action includes reduction of inflammation and inhibiting cox enzymes. Prolonged use of NSAIDS may cause gastritis and worsens the gastric ulcers.
Oral Steroid Medications
Prednisolone and other oral steroid medications are also prescribed to treat acute disc herniation. The steroids reduces the inflammation by suppressing the immune system of the body.
Nerve stabilizers : Nerve stabilizing drugs such as vitamin are given to make the nerves strong and healthy. Myocobolamin is the common vitamin given in case of disc herniation.
Losing weight also helps in relieving the severity of herniated disc pain. Decreased weight reduces the pressure on the vertebral disk.
Epidural Steroid Injections
Injections of cortisone are administered directly to the area of nerve compression in the vertebral region. These steroids have quick anti-inflammatory action relieves the pain because of compression on the nerves at the site of disk herniation.
Surgery for treatment of a disc herniation
When all above mentioned methods of treatment fails to correct deformity related to disc herniation, disk herniation surgery is the treatment option to correct the disc bulging. Surgery is recommended when all the treatment options becomes ineffective to correct disc herniation. Surgery has a success rate in most patients and with doctor’s advice and using the belts to waist, the patient can perform the normal activities after disc herniation surgery. Disc herniation Surgery helps in relieving the symptoms and patient feels some comfort after the treatment.