Disc Herniation: Causes, Symptoms, & Treatment

There are different types of disc-related issues, each classified based on the location and extent of the problem.

Protrusion (Bulge)

In a disc protrusion, the outer layer of the disc is intact, but the inner material pushes against it, causing a bulging of the disc. This bulge may press on nearby nerves, leading to symptoms. This, however, is not a herniated disc.

Prolapse 

Disc prolapse involves a more significant displacement of the disc material, where the outer layer is still intact but stretched. This can result in compression of spinal nerves and cause symptoms.

Extrusion

An extruded disc occurs when the inner material breaks through the outer layer but is still connected to the disc. It may form a distinct "neck" or connection to the disc.

Sequestration

Sequestration is the most severe form of disc herniation. It happens when the inner material breaks free from the disc and is no longer connected. This detached fragment can move into the spinal canal, potentially causing compression and nerve irritation.

Locations

Disc herniations can occur in various parts of the spine, and the symptoms may vary depending on the location. Here are the common locations of disc herniations:

Cervical Disc Herniation (Neck):

• Herniations in the cervical spine (neck) can affect the discs between the vertebrae in this region. Symptoms may include neck pain, shoulder pain, arm pain, numbness, tingling, and arm weakness.

Thoracic Disc Herniation (Upper/Mid Back):

• Thoracic disc herniations are less common than those in the cervical or lumbar spine. When they do occur, they may cause mid-back pain and discomfort. Symptoms may include pain radiating around the chest, abdomen, or into the legs.

Lumbar Disc Herniation (Lower Back):

• Lumbar disc herniations are the most common, affecting the lower back. Symptoms may include lower back pain, sciatica (pain radiating down the buttocks and legs), numbness, tingling, and weakness in the legs and feet.

The spine consists of bones (vertebrae) that are stacked upon one another. Each vertebra is connected to the other by an intervertebral disc. The intervertebral discs help increase the flexibility of the spine and function as shock absorbers. Each individual intervertebral disc consists of a tough outer fibrous layer surrounding a jelly-like inner layer.

A disc herniation, or slipped disc, can describe a tear of the outer fibrous layer of the intervertebral disc with or without protrusion of some of the inner gelatinous layer. In a disc herniation, a tear of the outer fibrous layer can cause significant pain that is usually localised to the neck or back, depending upon which disc is involved. If there is also a bulging of the inner gelatinous layer that irritates or compresses one of the nerves around the spine, this can result in significant pain, numbness, weakness or tingling that extends into a limb. This is most often seen in the legs and is commonly referred to as sciatica.

Disc herniation can occur following a specific injury or episode of heavy lifting. More commonly, however, disc herniation occurs as a result of age-related wear and tear. As we age our intervertebral discs become stiffer and are more at risk of rupturing.

In most instances, the pain from a disc herniation gets better on its own and does not require any treatment. More than 9 out of 10 people with a disc herniation will improve within six weeks.

Very occasionally, if a disc herniation is very large or in certain locations, it can cause compression of the spinal cord or certain important nerves. In these rare instances, more urgent investigation and treatment may be required.

When should I see my doctor?

If you develop severe neck or back pain following an injury you should seek urgent medical attention. If your symptoms have any of the following associated features, you should seek urgent medical attention;

• Numbness or weakness that extends down both arms or both legs.
• Numbness around your genitals or bottom
• Loss of control of your bowels or bladder
• Fevers or feeling generally unwell.

If you do not have any of the above features, you should see your doctor if your symptoms have failed to improve after six weeks or if they are associated with swelling, pain worse at night or recent unintentional weight loss.

The doctor will ask you about your symptoms and examine you. In the absence of any concerning features, you may be given advice regarding exercises to help relieve your symptoms in addition to simple pain medications. You may be referred to a physiotherapist in the first instance, depending upon the local services available. On occasions, depending upon your symptoms and your examination, you may be sent for further investigations which can include blood tests, X-Ray or MRI scans. If you have any concerning symptoms or features on examination, your doctor may send you to the hospital for further investigation and treatment.

In 9 out of 10 people, a disc herniation gets better without requiring treatment. If your symptoms do not improve you may be referred to a spinal surgeon. Further treatments available for disc herniation include injections to relieve your pain or surgery to remove the prolapsed disc.