Is Your Neck and Back Pain Coming From a Herniated Disc?
What is a Herniated Disc?
The spine is made up of a series of small bones called vertebrae that stack on top of each other. For reference purposes, the spine is divided into 5 areas: the cervical region that includes the top 7 vertebrae that form your neck; the thoracic region that contains the 12 vertebrae of your upper back; the lumbar region containing 5 vertebrae of the lower back; the sacral region containing 5 vertebrae of your buttocks, and the coccyx, or tailbone.
Thirty-three total vertebrae are supported by intervertebral discs that cushion and separate each vertebra. Each of these discs has a tough outer shell composed of fibrous tissue and is filled with a soft interior. When too much pressure is applied onto the disc, whether because of a traumatic accident or natural cause, the exterior shell can rupture leading the soft center to begin to show through a rip in the shell. This is called a herniated disc.
Over time, spinal discs lose elasticity and become prone to rupture, forming the ideal conditions to cause a herniated disc. The outer fibers of the disc form the annulus fibrosus, which is composed of sheets of collagen fibers. The nucleus pulposus is a loose network of fibers suspended in a mucoprotein gel, or the “filling” of the disc.
Types of Herniated Discs
Altogether there are three main types of herniated discs:
Contained Disc Herniation: When the annulus has ruptured but the nucleus has not yet pushed through, this is referred to as a contained disc herniation.
Extruded Disc Herniation: A disc is considered extruded if the nucleus has broken through the annulus but is still attached to the disc.
Sequestered Disc Herniation: When the nucleus pushes through and detaches from the disc altogether this is considered a sequestered disc herniation.
Causes of a Herniated Disc
With age, spinal discs become dehydrated and stiff, causing them to be less able to respond to compression. It is also possible to acquire a herniated disc through a sudden and intense twisting motion or a sudden strain from improperly lifting something heavy. If your job requires lifting, pulling, pushing, bending, and twisting, you are at increased risk for disc herniation. Being overweight can also put excess strain on your spinal discs.
A spinal disc can rupture from a sudden influx of pressure or even from a small amount of force. For example, falling from a ladder can have a great amount of force on the spine, depending on the position in which you land. If you fall hard enough, you can either break a vertebra or rupture a disc. In addition, small amounts of force over time cause the annulus to weaken. Eventually, when the annulus becomes weak enough, a simple motion like lifting or bending without applying too much pressure can become too much for the disc causing it to rupture. The weakened disc ruptures from an action that would not have caused it to rupture a few years earlier.
Symptoms of a Herniated Disc
The first sign you experience when you have a herniated disc is unquestionably pain. The pain can be sensed directly over the sore disc or in the extremities of the body. Local pain is caused by inflammatory chemicals that are released at the moment the tear in the annulus occurs. When the nucleus begins to push against nerves exiting your spinal canal, you may experience a condition called referred pain felt in the upper or lower body limbs.
Different symptoms arise depending on where the disc is located. In the thoracic area, a herniated disc can cause pain that feels like it’s coming from the heart, abdomen, or kidneys when it puts pressure on the nerves in these areas. These herniated discs can sometimes press against the spinal cord leading to a variety of symptoms:
Thoracic (Mid Back)
•Muscle weakness, numbness, or tingling in one or both legs
•Increased reflexes in one or both legs causing exaggerated movement
•Changes in bladder or bowel function
•Paralysis from the waist down
In the lumbar region, disc herniations cause leg and back pain The leg pain follows the path of the compressed nerve. The radiating pain is accompanied by motor, sensory, and reflex loss.
Lumbar (Lower Back)
•Lower back pain
•Pain traveling from the lower back down to the leg(s).
•Tingling and numbness in the leg(s), feet, and/or toes.
•Pain traveling from neck, through the shoulder and into the arms
•Tingling and numbness in the arm(s), hands, and/or fingers.
Treatment Options for a Herniated Disc
The majority of herniated discs heal on their own or with the help of physical therapy and special exercises designed to minimize the pain a herniated disc causes. More severe herniations may require surgery.
•Neck collar traction
•Oral or epidural steroids
•Minimally Invasive Endoscopic Laser Spine Surgery (Artificial Disc Replacement, Discectomy)
How to Prevent a Herniated Disc
The best way to prevent a herniated disc is through some simple lifestyle changes. It is important to exercise every day, especially to strengthen your core and back muscles to better support your spine. Maintaining a healthy weight eliminates unnecessary pressure and reduces risk. It is also important to practice proper posture, especially if your occupation requires you to be seated for hours on end. If you have a sedentary office job, try to get up once per hour for a short walk and stretch.
Surgery for a Herniated Disc
When considering surgical solutions for your herniated disc, remember that less is more. Minimally invasive endoscopic surgery that does not involve implantations is the safest course to explore before your other options. Recovery time is quick compared to open back surgery and it can be performed in an outpatient setting. It usually requires only local anesthesia. Read further about the benefits of this revolutionary surgical technique.
Do you think you are a candidate for minimally invasive endoscopic laser spine surgery? Please contact the Spine Institute at 973-538-4444 to schedule a consultation with Dr. Marc Cohen for a free MRI review at one of our New Jersey locations.