When to Seek Emergency Care for a Herniated Disk

The bones (vertebrae) that form the spine in the back are cushioned by discs. These discs are round, like small pillows, with a tough, outer layer (annulus) that surrounds the nucleus. Located between each of the vertebra in the spinal column, discs act as shock absorbers for the spinal bones.

A herniated disc (also called bulged, slipped or ruptured) is a fragment of the disc nucleus that is pushed out of the annulus, into the spinal canal through a tear or rupture in the annulus. Discs that become herniated usually are in an early stage of degeneration.

Herniated discs can occur in any part of the spine. Herniated discs are more common in the lower back (lumbar spine), but also occur in the neck (cervical spine). The area in which pain is experienced depends on what part of the spine is affected.

Causes

A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as one ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.

Certain individuals may be more vulnerable to disc problems and, as a result, may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families with several members affected.

Symptoms

Most herniated disks occur in the lower back but they can also occur in the neck. Signs and symptoms depend on where the disk is situated and whether the disk is pressing on a nerve. Herniated disks usually affect one side of the body. The symtoms include arm or leg pain/ numbness or tingling/ weakness.

You can have a herniated disk without symptoms. You might not know you have it unless it shows up on a spinal image.

Treatment

Conservative treatment — mainly modifying activities to avoid movement that causes pain and taking pain medication — relieves symptoms in most people within a few days or weeks.

Your doctor might suggest physical therapy to help with your pain. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.

Few people with herniated disks require surgery. Your doctor might suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to have:

In nearly all cases, surgeons can remove just the protruding portion of the disk. Rarely, the entire disk must be removed. In these cases, the vertebrae might need to be fused with a bone graft.

Prof Dr Haradhan Deb Nath,

Neurosurgery Department,

Labaid Specialised Hospital