The neck and low back are the most common spinal regions where a disc herniates. A herniated disc is often referred to as a bulging disc, ruptured disc, or slipped disc. However, discs do not slip and there is a difference between a herniated and bulging disc. A herniated disc ruptures through the tough fibrous outer ring that contains the gel-like inner core—the nucleus pulposus. A bulging disc is a contained disc disorder, meaning none of the nucleus pulposus is shed outside the disc.
Although a cervical (neck) or lumbar (low back) disc may suddenly herniate, often the process of disc herniation is gradual. The illustration below depicts four stages of disc herniation. Extrusion and sequestration represent herniated discs.
Symptoms of Disc Herniation
The foremost symptom is sharp, acute pain. Pain and related symptoms are caused by nerve compression. When a disc bulges or herniates, nearby nerves may become compressed, resulting in inflammation and pain. Neurologic (nerve-related) symptoms may include numbness, tingling, and weakness. Sometimes pain travels into another part of the body (eg, arm, leg). This type of pain and related symptoms is called a radiculopathy.
- Cervical herniated disc: pain and symptoms may be felt in the neck, upper back, shoulders, arms, or hands.
- Lumbar herniated disc: pain and symptoms may be felt in the low back, buttocks, thighs, below the knees, or feet.
Mid-back or thoracic disc herniation is not as common because the thoracic spine attaches to the rib cage; and creates a structure less susceptible to disc herniation.
Diagnosing a Herniated Disc
Aside from the neurosurgeon taking an in-depth medical history, he performs a comprehensive physical and neurological examination. These examinations assess the patient’s pain, symptoms, and evaluate physical function such as walking and range of motion (eg, spinal rotation, flexion, extension). Sometimes, pain related to disc herniation causes the patient to lean or list to one side. Therefore, much about the disorder can be learned by simply observing the patient.
Diagnostic tests may include:
- CT scan
An MRI is often the test of choice for diagnosis of a herniated disc. However, a CT scan may be helpful because it provides better visualization of the bony anatomy of the spinal column. Your neurosurgeon only recommends diagnostic imaging or other tests that are essential to an accurate diagnosis.
Treatment of a Herniated Disc
Most patients with a disc herniation do not require spine surgery. Rather, non-operative therapies are often very effective in helping the patient through the acute pain phase, and during injury recovery.
Typical non-surgical treatment options may include the following:
- Activity modification with a gradual return to protected movements.
- Depending on where the disc has herniated (eg, neck, low back), the patient may be told to avoid prolonged sitting, bending, lifting, reaching overhead, and/or twisting. Avoiding certain movements can help decrease the amount of stress and pressure on the spine, which may reduce nerve compression.
- Medications may include anti-inflammatory drugs, analgesics, muscle relaxants.
- Physical therapy
- Spinal injection of an anti-inflammatory near the affected nerve root to help reduce inflammation and irritation.
Spine surgery to treat the herniated disc is recommended only after the above treatments fail to adequately relieve the patient’s pain and related symptoms. If surgery is recommended, the patient is involved in the decision-making process, which includes a discussion about the potential benefits and risks of a procedure.
The neurosurgeons at Charleston Brain and Spine are highly trained spine specialists. Be assured that your care is our utmost concern. We have years of experience in the diagnosis and treatment of herniated discs in the neck and low back. Just because we are a neurosurgical group, does not mean that surgery is the only treatment we offer! Rather, we offer a wide range of non-surgical treatments.