By Walter N. Rabhan, MD
The spine is made up of bones called vertebrae separated by discs. Vertebral discs hold the bones of the spine and enable mobility of the back. Nerve roots are located all throughout the spine. So, when a spine has a weak spot, it irritates the nerve root, which can cause a disc herniation. Also called a ruptured disc, this condition can be painful and result in limited mobility. Let’s take a look at the degrees of the condition, its symptoms, risks and the ways we diagnose disc herniation.
Degrees of Disc Herniation
There are degrees of disc herniation. Based on the severity of the condition, the treatment will vary. The three degrees are:
A mild bulging disc is still in continuity with the spine. It causes mild swelling, mild to moderate pain, and can usually be managed without surgery.
Ruptured discs push into a nerve, causing moderate to severe pain, numbness and/or tingling in the legs.
The most severe type of disc herniation, in the case of an extruded disc a piece of the disc has actually broken off, causing severe leg pain, and other possible neurological symptoms.
Symptoms of Disc Herniation
The most common symptom of disc herniation is pain in the back that radiates into the top of the buttocks and into the legs. Discs can herniate to the left or right side, or in the mid-back. Mid-back herniation is not usually accompanied by leg pain, though there may be some pain in the upper buttocks. Right and left herniation will present with pain that radiates down the leg on the same side of the disc rupture.
Running, twisting, and increased physical activity can aggravate symptoms of a herniated disc. Even coughing and sneezing can exacerbate symptoms because they increase pressure within the spinal canal.
People with disc herniation can also experience tingling or pain in the leg that can be confused with hamstring pain. Additionally, individuals with extruded disc can experience symptoms other than pain.
Risks/Problems Associated With a Herniated Disc
Assuming the patient has no neurological abnormalities and all lower extremity nerve function is normal, the only risk is continued pain. The pain can be bad enough to keep someone out of work, to limit their mobility and to impact their quality of life. With severe ruptures or extruded discs, nerve damage can be involved. The patient will experience weakness in the muscles of the legs, limping, and, in extreme cases, loss of bladder and/or bowels.
Testing, Diagnosis and Treatment of Disc Herniation
In order to properly diagnose a herniated disc, the doctor will inspect the patient while they walk and check the motion in the spine. The doctor will check the patient’s reflexes, motor strength in their lower extremities, and sensation on the inside and outside of the leg. Additionally, the doctor will apply pressure to the sciatic notch – the central portion of the buttock where the nerves pass into the leg – to see if there is increased pain.
If patients have a ruptured disc they may have involuntary muscle spasms when their back is pulled to one side or the other.
Some ailments present with similar symptoms as disc herniation. Some back pain is actually spinal stenosis, a condition with pain symptoms identical to a herniated disc but with a different cause altogether. A doctor will use an MRI to differentiate between the two, along with the findings upon examination.
If a patient is diagnosed with disc herniation, treatment will vary depending on the severity of the condition. In most cases, rest, anti-inflammatory medication, physical therapy, and cortisone injections will alleviate pain. If the patient is still uncomfortable, if there is a progression of symptoms, or if the patient loses bladder and bowel control, surgery is necessary.