What is a herniated disc?

A herniated disc (slipped disc, prolapse, discusprolaps, sequester) is a perforation of a part of the disc nucleus through its fibrous ring. In the spine, 23 discs sit like small shock absorbers between the vertebrae and with it they take on a buffering function. They consist of a soft, gelatinous core (pulpous nucleus) and a solid outer fiber ring (fibrous annulus), which provides its lamellae for the necessary stability.

In case of permanent incorrect or excessive stress and age-related wear, the disc elasticity will be reduced causing small tears in the outer fiber ring.

This allows a part of the gelatinous core to emerge from the ring and enter the spinal canal. In contrast to the protrusion, the nucleus of a herniated disc presses directly on the nerve root. Smaller herniated discs are called prolapse and larger or extended - as a sequester.

Basically, a herniated disc can occur in any area of ​​the spine. However, the most affected is the lumbar spine - medically also called lumbar herniated disc or herniated disc. Damage to the cervical spine is less common and rarely in the thoracic spine.

Frequency of a herniated disc

Statistically, about 80 percent of people suffer from occasional pain and about 40 percent have regularly recurring back pain. Usually Disc hernia is seen in patients between the ages of 45 and 55 years. Women are more likely to suffer a herniated disc than men.

How does a herniated disc develop? The most common causes

There are several factors that may be the cause(s) of a herniated disc. First of all, it must be said that behind a herniated disc there is usually year-long, age-related wear of the intervertebral disc. It is not a secret that our discs age with us. At the same time, this does not mean that they must necessarily age, but of course, over time they lose their elasticity and the ability to store water. These changes, in turn, increase the risk of tears in the disc ring which will cause a herniated disc. 

This risk is then reinforced by additional burdens that affect the disc such as overweight, lack of exercise, postural defects, and heavy lifting. Of course genes can be also a cause.

Symptoms - how does a hernia manifest?

If the hernia puts a lot of pressure on the nerves, depending also on the location of the herniated disc, there can be many symptoms. A herniated disc, usually introduces itself, which means: anyone who has severe back pain for a whole week which radiates to the legs and arms should consult a doctor. 

Three types of herniated disc – in the cervical, thoracic and lumbar spine. 

  • Our body weight puts extra pressure on the vertebrae and discs of the lumbar spine, that´s why in this point of our spine, hernias are more common. A herniated disc in the lumbar spine creates stinging pain in our lower back which radiates through the leg and can also reach the foot; accompanied with numbness and/or sensory changes such as tingling. Any movement can increase the pain, even sneezing and coughing, that is the reason why people who suffer from lower back pain prefer to take a resting position. This type of hernia can also cause numbness and paralysis in the legs and also bladder and bowel dysfunction. Moreover, numbness may take place in the anal and genital area, even within the thighs. In cases of weakness of legs and/or bladder dysfunction, you should consult immediately a doctor because an acute treatment must be performed!
  • The herniated disc in the cervical spine is often associated with neck pain which radiates into the shoulder blades and arms sometimes into the hand that in addition, can cause a feeling of numbness in the arms and fingers. Also, headaches, difficulty to concentrate, dizziness, tinnitus, balance disorders or visual disturbances can occasionally occur. Weakness in the arms or Hands indicates a stronger herniated disc.
  • Herniated discs occur rarely in the thoracic area. The manifested symptoms can be back pain, which usually radiates laterally. And with this kind of pain radiation, an acute heart attack should not be excluded.
  • All types of herniated disc are associated with tension, loss of strength, restricted mobility and/or sleep disturbances.

The diagnosis - how can we prove a herniated disc?

An accurate diagnosis is done through a deep conversation between the doctor and the patient in which he must answer some important questions such as: What symptoms do you have? Where exactly do they radiate - in the leg or in the arm? Since when do the complaints exist? What triggered your complaints? Does the pain increase when you cough, sneeze or move? Can you sleep at night? Do you have problems urinating or defecating? Do you sometimes stumble? Do objects fall out of your hand? Do you have tingling or numbness? Has the concentration, bladder function, sight changed? Which therapies have you already tried?

After this conversation a neurological examination could be necessary. It would help the doctor  to check your reflexes, your sensitivity, your mobility and possibly the reaction speed of your nerves. Depending on whether and where the pain radiates the specialist can understand in which point the hernia is located.

Of course, your psychosocial and occupational conditions will be taken into consideration, but what allows the doctor to see the concrete changes deeply is an MRI. It will show the herniated disc, its dimension, and position, if there´s arthrosis, the level of the disc degeneration, the instability and changes of the neural structures (myelopathy) and other important information.

Which treatment is the right one?

In order to find the best treatment and make the best choice, attention must be paid to the following factors:  

  • Ailments: pain, discomfort, loss of strength, bladder disturbances;
  • The success of previous therapies and its duration, side effects of previous treatments;
  • The general condition of the patient: severe heart disease, diabetes;
  • Neurological findings: sensory disturbances, reflex deviations, motor failures or atrophies;
  • Results of the MRI: small or large hernia, accompanied by narrowing, instability;
  • Psychosocial factors, occupation, career, etc.;

As a result of this examination, the advantages and disadvantages of different treatment options are explained in detail and then a clear recommendation is given. We will recommend you a therapy that should not only alleviate the symptoms but also eliminate the cause, in order to achieve lasting relief of the pain and especially prevent irreversible nerve damage.

Different approaches to the treatment of herniated discs

  • Conservative therapies: medication, injections, computed tomography (CT) - controlled injections, infusions, physiotherapy, manual therapy, osteopathy, electrotherapy, and others;
  • Minimally invasive procedures such as percutaneous laser discus decompression (PLDD) or percutaneous nucleotomy (PN) in cases of small disc hernia;
  • Microsurgery for moderate and huge herniated discs especially when it is accompanied with spinal canal stenosis;
  • For a herniated disc recurrence, the split of the fiber ring (fibrous annulus) is closed with a special suture technique;
  • Especially in the cervical spine, the disc can be replaced with a disc prosthesis or with a cage;

Only a detailed conversation with a specialist will determine which one of the above mentioned treatment is the best for you.

Possible prognosis?

Can I avoid a herniated disc? And, if I got a one, how can I live with it? Well, just to make it clear, there is no way to know how to fully prevent a herniated disc, BUT you can obviously strength your spine and reduce the risks. In other words: try to live a back-friendly everyday life. The most important factors to prevent a herniated disc are: to have a strong back-musculature and to avoid putting so much pressure on your spine:

  • Pay attention to your weight! Obesity puts additional strain on the back and the intervertebral discs.
  • Always lift heavy objects from a squatting position keeping your back straight.
  • Move! With gymnastics and sports, the back muscles are strengthened and the spine is relieved. For example, swimming is one of the back-friendly sports, and - if you like cycling – keep pedaling!
  • Take care of your mattress. Make sure that you do not stay in an unfavorable position at night. Basically, after seven years the mattress is… gone!
  • If you have a job in which you have to sit down for long periods, you should do two things: Be sure to sit on an ergonomic chair with height-adjustable seats … and do not sit for hours. Get up, walk a few steps, stretch yourself up. Let your colleagues laugh… You are doing a great favor to your spine!

How should you behave after a herniated disc?

We recommend to begin with physiotherapy as soon you can. Specific exercises relieve the spine, massages, aqua gymnastics and back-friendly sports are helpful. Of course, you should avoid movements that strain your back and the intervertebral discs; so do not lift or carry heavy objects, do not sweep the ground in a stooping position or shovel sand.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

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The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

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Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.