A herniated disc refers to a problem with the cushion between the vertebrae. They sit between the bones that stack to make the spine. A spinal disc is made up of two main components. The first is a soft jellylike center called the nucleus pulposus. Surrounding this jellylike substance is a tougher exterior known as the annulus fibrosis. When doctors use the term herniated disc they are referring to the classic representation, where some of the nucleus pushes through the annulus.
There are four types/classifications of disc herniations. A bulging disc, protruding disc, extruded disc and sequestered disc.
The best comparison I use for my patients is comparing a disc to a jelly doughnut. A bulging disc is when the outer part of the doughnut expands more than normal. A protruding disc is when some of the jelly expands into the dough part of the doughnut. An extruded disc is when the jelly completely exits the dough part of the doughnut often affecting the nerves that exit the spinal cord or the spinal cord itself. Lastly, a sequestered disc is when part of the jelly that exits outside the doughnut completely detaches and free floats into the spinal area. Herniated discs most often occur in the lower back and can result in pain, numbness or weakness in an arm or leg. Fortunately, with proper treatment symptoms tend to improve over time without the need for major surgery.
Causes?
Most disc herniations are caused by wear and tear of the disc as people age. This is referred to as disc degeneration. As people age disks become less flexible and more prone to tearing or rupturing. Twisting and turning with excessive weight is a very common way of causing a herniated disc. Falling on the low back can also cause herniated discs. Factors that can increase the risk of disc herniations include excessive body weight, physically demanding jobs, smoking, frequent driving or living a sedentary lifestyle.
Treatment
Treatment includes surgical interventions such as a discectomy, spinal fusion, artificial disc, laminectomy or spinal injections. A discectomy involves shaving the part of the disc that is affecting the associated nerve or spinal cord area. Spinal fusion involves completely removing the affected disc and using bone material or metal to stabilize the area. Artificial discs are used to replace the damaged disc with one of similar functions. This allows mobility to be retained in that part of the spine. Laminectomies involve taking part of the spine out to allow breathing room for the affected disc area. Spinal injections are used as a steroid or numbing medicine to decrease pain and inflammation around the disc area.
Before these actions are considered it’s important to explore conservative options such as chiropractic care and physical therapy. Physical therapy can strengthen and stabilize areas around the disc to improve symptoms. I preach to all my patients that core strength is very important as it takes pressure off of the low back and can help in reducing and preventing disc issues. I use a technique called flexion distraction which acts as a vacuum, enabling the herniated disc to conform to its proper position within the spine vertebrae. It also helps for proper joint movement and relaxation of muscles and ligaments within the spine area.
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