Disk herniation: causes, symptoms & treatment

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

Protrusion (Bulge)

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

Prolapse

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

Extrusion

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

Sequestration

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

Locations

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

Cervical Disk Herniation (Neck):

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

Thoracic Disk Herniation (Upper/Mid Back):

• Thoracic disk 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 Disk Herniation (Lower Back):

• Lumbar disk 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) stacked upon one another. Each vertebra is connected to the other by an intervertebral disk. The intervertebral disks help increase the spine's flexibility and function as shock absorbers. Each intervertebral disk has a tough outer fibrous layer surrounding a jelly-like inner layer.

A disk herniation, or slipped disk, can describe a tear of the outer fibrous layer of the intervertebral disk with or without protrusion of some of the inner gelatinous layer. In a disk herniation, a tear of the outer fibrous layer can cause significant pain, usually localized to the neck or back, depending on which disk is involved. Suppose 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 called sciatica.

Disk herniation can occur following a specific injury or episode of heavy lifting. However, disk herniation occurs more commonly due to age-related wear and tear. As we age, our intervertebral disks become stiffer and are more at risk of rupturing.

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

Occasionally, if a disk 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. Without any concerning features, you may be given advice regarding exercises to help relieve your symptoms in addition to simple pain medications. Depending upon the local services available, you may be referred to a physiotherapist. On occasion, 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.

A disk herniation gets better in 9 out of 10 people without requiring treatment. You may be referred to a spinal surgeon if your symptoms do not improve. Further treatments for disk herniation include injections to relieve your pain or surgery to remove the prolapsed disk.