The intervertebral disc is made up of strong connective tissues which hold one vertebra to the next and acts as a cushion or “shock absorber” between the vertebrae. The intervertebral disc is made of a tough outer layer called the annulus fibrosis and a gel-like center, the nucleus pulposus. As we age, the center of the disc may start to lose water content, making the disc less effective as a cushion. As the disc deteriorates, the outer layer can also tear. This can allow displacement of the disc’s center through a crack in the outer layer, into the space occupied by the nerves and spinal cord.
What are the symptoms of a Herniated Cervical Disc?
A herniated cervical disc may press on the nerves and cause pain, numbness, tingling, or weakness in your arms and shoulders, as well as neck pain.
What are the symptoms of a Herniated Lumbar Disc?
A herniated lumbar disc can press on the nerves in the spine and may cause pain, numbness, tingling, or weakness of the legs, as well as back pain.
How is a Herniated Disc Diagnosed?
In addition to your symptoms, a herniated disc can be diagnosed on physical exam by your treating Primary Care Physician or Neurosurgeon. Your physician may have you obtain diagnostic imaging to aid in confirming the diagnosis. An X-ray image can show bone spurs and narrowing of the disc space as the spine ages and deteriorates. Computed tomography (CT) and magnetic resonance imaging (MRI) scans provide more detailed pictures of all the spinal elements (vertebrae, discs, spinal cord, and nerves) and can identify most disc herniations.
What is the Treatment for a Herniated Disc?
Depending on the severity of your symptoms, a course of non-surgical treatment may be prescribed by your primary care physician or neurosurgeon. This typically involves a combination of medications, physical therapy, and epidural steroid injections.
Medications that are typically prescribed include pain medications to help with your symptoms as well as anti-inflammatory medications, such as ibuprofen, to help decrease inflammation around the nerves in your spine. Occasionally other medications such as Lyrica and Neurontin are prescribed to help with nerve pain.
In addition to medications, a physical therapy program may be incorporated as a form of non-surgical treatment. A physical therapy program usually begins with stretching exercises to restore flexibility to tight muscles in the neck, trunk, arms, and legs. Depending on your response to physical therapy, stretching exercises may progress to cardiovascular exercise and strengthening exercises for your arms, legs, and trunk muscles.
Epidural steroid injections may also be prescribed and involve injection of corticosteroids into the area around your spinal cord and nerves in order to reduce inflammation.
For patients whose pain does not improve with non-surgical treatments, surgery may be necessary. In addition, surgery may be indicated urgently if you have significant weakness or bowel/bladder symptoms. The goal of surgery is to remove the portion of the disc that is pushing on the nerve (discectomy).
Depending on the location of the herniated cervical disc, the operation may be performed from the front of the neck (anterior approach) or from the back of the neck (posterior approach). Because removal of the herniated cervical disc fragment from the front removes most of the disc as well as the herniated portion, a fusion is typically performed to stabilize the spine. During a cervical fusion procedure, a bone graft is placed between cervical vertebrae to support the spine and compensate for the bone and discs that have been removed. This is followed by placement of a small plate and screws that hold the spine together while it is healing and fusing.
A discectomy is also the surgical procedure performed for a herniated lumbar disc. In order to see the disc clearly, it is usually necessary to remove a small portion of the lamina, the bone behind the disc (hemi-laminotomy). Only the portion of the disc that has herniated out is typically removed. Unlike cervical discectomy, fusion is typically not performed, unless there is recurrent disc herniation or evidence of instability in the spine. The bone and ligaments overlying the nerve root may also be removed to create more room for the nerve – a procedure called foraminotomy.
Discectomy is a very effective procedure in relieving arm and leg pain, and is less effective for neck or back pain. Some numbness may persist after surgery, depending on how much damage to the nerve already occurred from the disc herniation. Weakness typically improves as well, especially if it is not severe and has not been present for a long time.
Where Can I Find More Information?
North American Spine Society. (2009). Herniated Cervical Disc. http://www.knowyourback.org/Documents/herniated_cervical.pdf
North American Spine Society. (2009). Herniated Lumbar Disc. http://www.knowyourback.org/Documents/herniated_lumbar.pdf