Disk Herniation

Disk Herniation

Disk Anatomy

Disk herniation is the most common cause of back pain. The intervertebral disks are flat and round, present between the vertebrae and act as shock absorbers when you walk or run. There is a soft, gelatinous material in the center (nucleus pulposus) that is encased in strong elastic tissue to form a ring around it called annulus fibrosus.

What is a Disk Herniation?

Disk herniation is a condition where the central nucleus pushes through the outer edge of the disk, causing a bulge that compresses the spinal nerves. 

Causes of Disk Herniation

Aging, injury or trauma may cause the annulus fibrosus to tear, resulting in protrusion of the nucleus pulposus. This may compress the spinal nerves and/or spinal canal. The bulging disk may even break open, releasing the gelatinous material, which is a chemical irritant, causing inflammation of the spinal nerves. 

Obesity, sedentary lifestyle and smoking increase the risk of lumbar disk herniation.

Symptoms of Disk Herniation

The symptoms of lumbar disk herniation include:

  • Mild to intense back pain, making it difficult to bend
  • Numbness and weakness in the leg or foot leading to the sensation of tingling (pins and needles)
  • Leg and/or feet pain making it difficult to walk or stand
  • In rare cases, loss of bowel and bladder function (cauda equine syndrome), requiring immediate medical attention 

Diagnosis of Disk Herniation

The diagnosis of disk herniation includes a thorough review of your medical history and a physical and neurological examination. Neurological examination is performed to indicate any neurological injury and involves the evaluation of reflexes and muscle weakness by various tests. To confirm the diagnosis, your doctor may order an MRI to evaluate changes in the disk and spinal nerves.

Treatment of Disk Herniation

Non-surgical Treatment of Disk Herniation

Non-surgical treatment is preferred over surgery and includes rest, activity modification, and pain medication, which include non-steroidal anti-inflammatory drugs, muscle relaxants, and epidural analgesic injections. Back braces are recommended for a few days to keep the lower back still and reduce mechanical pain due to movement. Physical therapy or acupuncture may be helpful in some cases.

Surgery for Disk Herniation

Surgery is considered in cases with significant leg pain, muscle weakness, and numbness that is unresolved after conservative treatment measures. Urgent surgery may be required if neurologic dysfunction or cauda equine syndrome occurs.

Microdiskectomy is the most commonly used surgical procedure for lumbar disk herniation. It involves the removal of part of the herniated disk causing nerve compression. It is a comparatively safe procedure, but some of the risks include infection, nerve damage, dural leak, or hematoma. Most patients undergoing surgery find significant respite in pain after the surgery.

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