Bulging/Herniated disc

What is a herniated disc?

Your spine is made up of 24 small bones, known as vertebrae, stacked on top of each other. In between each vertebrae, there is a rubbery pad known as a disc that acts as a cushion and prevents the vertebrae from rubbing against each other. Each disc has a harder exterior, known as the annulus, which surrounds an inner core, known as the nucleus. The nucleus contains loose fibers that are suspended in a gel-like substance. 

A herniated disc occurs when a fragment of the nucleus pushes out through the annulus as it is weak or torn. Consequently, the displacement of this disc presses on the nerves in the spine, often resulting in pain, numbness or weakness in your arms or legs. A herniated disc can occur in any part of the spine, but most commonly in the lower back.

A herniated disc is one of the most common causes of back pain, and occurs in 0.5 to 2 percent of the population annually [1]. However, a herniated disc can recover on its own, and pain will usually subside within 4 to 6 weeks. 

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MRI scan of a herniated disc in the lower back.

Taken from: https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disc-in-the-lower-back/

How will having a herniated disc affect me?

There are a few ways in which having a herniated disc may affect you in your daily life. Firstly, you may find it difficult or painful to walk and move around. As a result, this may bring discomfort and inconvenience to your life, especially if there is a job or event that requires you to move around often. Activities such as turning around and carrying objects may become extremely challenging as well. You may also find yourself stumbling more often than usual.

What does having a herniated disc feel like?

Radiating pain, numbness or tingling. The main tell-tale sign of a herniated disc is a sudden sharp or burning pain that shoots down your arms, buttocks or legs. In some cases, you may experience a tingling sensation instead, and in rare cases, numbness or paralysis. 

Restricted mobility. With a herniated disc, you may also find yourself unable to bend over, turn around or straighten your back properly. 

What are the causes and risk factors of herniated discs?

Aging. The most common cause of a herniated disc is wear-and-tear due to aging. As you age, parts of your body naturally begin to degenerate, including your spine. This aging process causes your annulus to gradually degenerate and weaken. Eventually, even the slightest strain or movement may cause your annulus to tear, resulting in a herniated disc. 

Trauma. Traumatic events, such as a fall or car accident, may also result in a herniated disc. 

Naturally, the biggest risk factor for a herniated disc is age. Individuals between the ages of 30 and 50 are most prone to herniating their discs [1]. 

In addition, smoking has been shown to accelerate disc degeneration and back pain [2]. A study has shown that those who smoke also have an 18.5% recurrence rate for disc herniation, a significantly higher risk that those who do not smoke [3]. 

How is a herniated disc diagnosed?

Medical examination. When visiting a doctor, your doctor will most likely conduct a thorough medical examination and several tests before definitively diagnosing your herniated disc. Your doctor may ask you about your medical history and test your strength and reflexes. 

Neuroimaging. In addition, your doctor may make use of imaging such as MRI and CT scans to have a detailed look at the spine. This will allow your doctor to locate free fragments of the herniated disc easily.

How do I prevent myself from getting a herniated disc?

As a herniated disc is often a result of natural wear-and-tear of the spine that comes with age, there is no certain way to completely prevent it. However, some ways to reduce your risk of herniating your disc include:

  • Exercising regularly. Exercising helps to strengthen your back muscles and keep your spine flexible. Some sports that are good for the spine include swimming and yoga.
  • Maintaining a good posture. Bad postures can create gradual changes to the natural curves of your spine. Thus, keeping your back straight while sitting down and sleeping on a firm mattress that adequately supports your spine may help to reduce your risk of herniated disc. 

How are herniated discs treated?

Rest. For most patients, a herniated disc will slowly recover by itself after a period of 4 to 6 weeks. Resting in bed, restricting physical activity and icing or heating the affected area will help to relieve some of your pain and accelerate the healing process. 

Epidural steroid injections. If the pain is still present after 6 weeks, your doctor may make use of epidural steroid injections. This is a minimally invasive procedure whereby your doctor, with the guidance of X-ray imaging, will first carefully insert a needle into a fat-filled area between the bone and the protective sac of the spinal nerves within your spine. Your doctor will then inject a medicine to help reduce pain and inflammation in your spine. 

Surgery. Only a small percentage of patients with herniated discs will need surgery. However, if your herniated disc does not heal after a few months or causes muscle weakness, difficulty in moving or a loss of bladder and bowel control, your doctor may opt to treat your herniated disc surgically. 

If you think that you may have a herniated disc, visit a doctor and seek medical attention immediately. 

References
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  1. Dydyk, A. M., Ngnitewe Massa, R., & Mesfin, F. B. (2020, November 20). Disc Herniation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441822/#:~:text=The%20incidence%20of%20a%20herniated 
  2. Shin, B.-J. (2014). Risk Factors for Recurrent Lumbar Disc Herniations. Asian Spine Journal, 8(2), 211. https://doi.org/10.4184/asj.2014.8.2.211
  3. Miwa, S., Yokogawa, A., Kobayashi, T., Nishimura, T., Igarashi, K., Inatani, H., & Tsuchiya, H. (2015). Risk Factors of Recurrent Lumbar Disk Herniation. Journal of Spinal Disorders and Techniques, 28(5), E265–E269. https://doi.org/10.1097/BSD.0b013e31828215b3 
  4. Ramachandran, T. S. (2019). Disk Herniation Imaging: Overview, Radiography, Computed Tomography. EMedicine. https://emedicine.medscape.com/article/340014-overview#a4