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Disc Herniation

A cervical (neck) or lumbar (low back) disc herniation is a common cause of pain.  The intervertebral discs; the discs between each vertebral body, work with other parts of the spine to absorb and distribute stress.  Each disc is made up of an annulus fibrosus; a tough tire-like outer band, and the nucleus pulposus; a gel-like inner substance. 

A disc herniation occurs when the nucleus pushes through the annular wall.  The nuclear material releases a chemical irritant that sets off a cascade of inflammation, nerve compression, and pain.

Symptoms
Typical symptoms of a cervical or lumbar disc herniation include:

Cervical Disc Herniation

Lumbar Disc Herniation

Neck pain

Low back pain

Movement may intensify pain

Bending, coughing, sneezing, other movement may intensify pain

Dull or sharp pain in the shoulders, upper back

Muscle spasm, cramping

Pain spreads (radiates) down into the arms, hands, or fingers (extremities).  Called cervical radiculopathy

Sciatica (pain, burning, tingling, numbness that extends into the buttocks and legs)

Tingling, numbness in the shoulders, upper back, or extremities

Leg weakness, functional loss

 
Risk factors
Sudden stress from injury or trauma can cause disc herniation.  Sometimes a disc herniation gradually develops over weeks or months.

Risks you control

  • Do not smoke
  • Maintain a healthy weight
  • Eat well; a balanced and healthy diet
  • Exercise
  • Practice good posture and body mechanics

Risks beyond your control

  • Growing older
  • Injury or trauma

Talk with your doctor
Sudden pain or pain that is severe, or that becomes chronic or progressive, requires evaluation by your doctor.  Perhaps your doctor has already diagnosed you with a bulging (has not broken through the anular wall) or herniated disc.  If that is the case, he will want to know about any new symptoms, especially weakness, problems with balance or when walking, or bladder or bowel dysfunction.

Diagnosis
Your doctor collects and compares information gathered while talking with you about your medical history and past and existing symptoms.  A physical and neurological examination looks for limitations of movement, balance difficulties, and what exacerbates and relieves pain.  During the exam he tests your reflexes, muscle strength, sensations, or other signs of neurologic loss.  Your doctor may order imaging studies such as plain x-ray, CT, or MRI to study and confirm you diagnosis to direct your treatment plan.

Treatment
Most cases of disc herniation do not require surgery.  Often, one or more non-surgical treatments are very effective at relieving symptoms.  These include:

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain; muscle relaxants to calm spasm; and, occasionally narcotic painkillers.
  • Cold/heat therapy
  • Spinal injections
  • Physical therapy: stretching to increase flexibility, therapeutic exercise to build muscle strength and endurance; posture and importance of maintaining good posture (ergonomics) at rest, work, and during other activities.
  • Alternative therapies, such as acupuncture

Surgery may be recommended if pain cannot be managed, spinal instability develops, or neurologic symptoms develop or progress.  Your doctor will explain why he recommends surgery and the type of procedure involved, including what to expect before and after surgery.

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