By: Russell Keener  —  March 4, 2011
 

What is a disk herniation?

The disks in your spine are thin, oblong struc­tures that serve as cush­ions between the bones of your back (ver­te­brae). Each disk is made up of a soft gel core sur­rounded by a tough, fibrous outer shell. This struc­ture allows the disk to be firm enough to main­tain the space between the ver­te­brae, but soft enough to com­press when

the spine flexes dur­ing bend­ing, lean­ing and turn­ing sideways.

In some peo­ple, a disk’s tough outer shell devel­ops an area of weak­ness or a small tear. When this hap­pens, part of the disk’s soft inner core can bulge out of its nor­mal posi­tion (her­ni­ate), pro­duc­ing a con­di­tion called a her­ni­ated disk. If the her­ni­ated disk presses on nerves in the nearby spinal canal, this can cause vari­ety of nerve-related symp­toms, includ­ing pain, numb­ness and mus­cle weak­ness. In the most severe cases, a her­ni­ated disk can com­press nerves that con­trol the bowel and blad­der, caus­ing loss of uri­nary and bowel control.

You may be at increased risk of a her­ni­ated disk if you work at a job that involves heavy lift­ing or exces­sive twist­ing or bend­ing.
There are three dis­tinct areas of the ver­te­bral col­umn where a her­ni­ated disk may occur:

• The cer­vi­cal (neck)
• The tho­racic (mid-back)
• The lum­bar (low-back)

Her­ni­ated disks are most com­mon in the lum­bar and cer­vi­cal areas. Her­ni­ated disks are rel­a­tively rare in the tho­racic region, where they account for only 1 in every 300 disk herniations.

Symp­toms

The first symp­tom of a her­ni­ated disk is usu­ally back pain in the area of the affected disk. If the inner core does her­ni­ate and press on a nearby nerve, the result­ing symp­toms vary depend­ing on the loca­tion of the her­ni­ated disk:

Cer­vi­cal Her­ni­a­tion can cause pain in the neck, shoul­der, shoul­der blade, arm or chest, together with numb­ness or weak­ness in the arm or fin­gers. If the pain is cen­tered in the chest and arm, it can mimic the chest pain of heart dis­ease. Occa­sion­ally, fre­quent uri­na­tion and headaches can occur.

Tho­racic Her­ni­a­tions tend to be vague, mis­lead­ing and long last­ing. There may be pain in the upper back, lower back, chest, abdomen or legs, together with weak­ness and numb­ness in one or both legs. Some affected peo­ple also com­plain of bowel or blad­der incontinence.

Lum­bar Her­ni­a­tions severe leg pain is the chief com­plaint. This pain is called sci­at­ica because it comes from pres­sure on the sci­atic nerve. It usu­ally begins in the lower back, then spreads into the but­tocks and down the back of one thigh and leg. Sci­at­ica typ­i­cally becomes worse if the patient coughs, sneezes, bears down or moves the back abruptly. While often relieved by rest, sci­at­ica may become worse with dri­ving or lift­ing. In addi­tion, there may be numb­ness, tin­gling or mus­cle weak­ness in the but­tocks or leg on the side of the pain. In rarer and more severe forms of lum­bar disk her­ni­a­tion, the nerve is com­pressed more exten­sively. If this hap­pens, addi­tional symp­toms can develop, includ­ing rec­tal pain; loss of bowel and blad­der con­trol; and numb­ness around the gen­i­tal area, but­tocks or backs of the thighs.

Diag­no­sis

Your doc­tor will review your med­ical his­tory, includ­ing any his­tory of fever, can­cer, steroid use or recent back injuries. Your doc­tor then will ask you spe­cific ques­tions about your pain:

• Have you had milder episodes of back pain in the past?
• Where is your pain located? Is it lim­ited to your back or does it spread into your shoul­der, arm, chest, but­tock or leg?
• When did your pain start? Did it begin when you tried to lift some­thing heavy, or was it trig­gered by a sud­den twist or bend of your back?
• What makes it feel bet­ter, and what makes it worse?
• Does the pain dis­ap­pear when you rest the affected area, or is it present even at rest?
• Have you noticed any numb­ness, tin­gling or mus­cle weak­ness in your arms or legs?
• Are there prob­lems with bowel or blad­der con­trol, rec­tal pain, or numb­ness in the but­tocks or gen­i­tal area?

After review­ing your med­ical his­tory and symp­toms, your doc­tor should do a thor­ough phys­i­cal exam­i­na­tion to rule out other ill­nesses that can cause back pain, such as can­cer or a bone infec­tion of the ver­te­brae. This gen­eral phys­i­cal exam will be fol­lowed by a more detailed exam­i­na­tion of your back, dur­ing which your doc­tor should look for dif­fer­ences between your right and left sides, mus­cle spasms, abnor­mal cur­va­ture, lim­i­ta­tion of move­ment, lack of flex­i­bil­ity, areas of numb­ness, and areas of ten­der­ness. Your doctor’s find­ings will help to rule out other types of back prob­lems that can cause sim­i­lar symptoms.

If you have symp­toms of lum­bar disk her­ni­a­tion, your doc­tor may ask you to do spe­cific maneu­vers, such as walk­ing on your toes, walk­ing on your heels, squat­ting and stand­ing, and flex­ing your ankle against resis­tance. Your doc­tor will want to do a straight leg-raising test. You will lie on your back with your legs straight. While you relax, your doc­tor slowly raises each leg indi­vid­u­ally to deter­mine the angle where your leg pain begins. Your doc­tor should also per­form a neu­ro­log­i­cal exam­i­na­tion, look­ing for changes in your reflexes, as well as for any evi­dence of mus­cle weak­ness or decreased sensation.

A mag­netic res­o­nance imag­ing (MRI) or CT scan may be nec­es­sary, if your symp­toms per­sist or worsen after sev­eral weeks of treat­ment, or if you are expe­ri­enc­ing numb­ness, tin­gling or burn­ing sen­sa­tion in your extrem­i­ties (arms and legs). Your doc­tor also may rec­om­mend an elec­tromyo­g­ra­phy, a test that ana­lyzes mus­cle and nerve func­tion to iden­tify sites of nerve com­pres­sion or irritation.

Pre­ven­tion

In many cases, it is not pos­si­ble to pre­vent a her­ni­ated disk. How­ever, if you have suf­fered from a her­ni­ated disk in the past, you may be able to decrease your chances of it hap­pen­ing again by:

• Avoid­ing activ­i­ties that require heavy lift­ing or repet­i­tive bending
• Prac­tic­ing good posture
• Main­tain­ing a healthy weight
• Fol­low­ing a physical-therapy pro­gram aimed at build­ing mus­cle strength in your back and improv­ing abdomen and back flexibility
• Exer­cis­ing reg­u­larly, espe­cially swim­ming and walking

Treat­ment

In some cases, a her­ni­ated disk will respond to con­ser­v­a­tive treat­ment which may include bed rest, warm baths, heat­ing pads, mus­cle relax­ers, ultra­sound, mas­sage or med­ica­tions, such as pain reliev­ers, anti-inflammatory drugs or mus­cle relax­ers.
When these more con­ser­v­a­tive mea­sures don’t work, epidural steroid injec­tions may be help­ful. This involves the care­ful injec­tion of a long-acting steroid and an anes­thetic into the space near the spinal cord and com­pressed nerves. These injec­tions are guided by X-rays or CT scan­ning so that the nee­dle can be placed pre­cisely in the proper loca­tion. If you have lost bowel or blad­der con­trol, if you have evi­dence of pro­gres­sive nerve dam­age, or if you have unre­lent­ing pain that per­sists despite weeks of con­ser­v­a­tive treat­ment, more aggres­sive treat­ment may be needed, includ­ing surgery. In most cases, this means remov­ing the disk (diskectomy).

When To Call a Doctor

Call your doc­tor imme­di­ately if you develop severe back pain, espe­cially if you also have pain or numb­ness in your arms or legs or if you lose con­trol of your bow­els or bladder.

Whether job injuries or car acci­dents have caused your disk her­ni­a­tion, you need an expe­ri­enced lawyer to review your case.  Mr. Keener has over 20 years of expe­ri­ence and a rep­u­ta­tion for treat­ing clients like fam­ily.  If you have been hurt on the job or in a car acci­dent, con­tact the Keener Law firm at 770–955-3000.