Disc Herniation: What is it?
Disc herniation sounds scary, but what is it really? Remember from Spine Anatomy 101 that the spinal disc is a squishy thing that sits in between the vertebral bodies–the bones that make-up the spine. Normally, the disc has a certain shape, a contour that slowly begins to change as the disc ages. Sometimes, the disc will bulge in a generalized fashion beyond the boundaries of the bones. Disc bulging is very common and normal as the disc gets older. When a disc herniates, a focal part of the disc is displaced beyond the vertebral body boundary. The difference between a bulge and a herniation is the amount of disc that is involved. The tricky part is that both bulges and herniations are found in people who have no pain.
Harry works as an accountant. All day long, he sits at his desk working with the computer. One morning, while brushing his teeth, he feels a sudden neck pain with a sharp, lacerating pain screaming down his arm. Later that night, he starts to feel numbness and tingling in his left little finger. The pain becomes so excruciating to the point he could hardly hold his head up at work. Worried about losing his job, he begins taking ibuprofen just so he could get through his day. Harry was scheduled to help his buddy move this weekend, but he will now have to say," no." He needs the rest. Remembering his times as a football player recovering from a Friday-night game; he will try to mend with ice, rest, and ibuprofen.
Harry’s story is a typical scenario for a painful disc herniation: sudden with signs of nerve pain radiating into the limb. Usually, a disc herniation is caused by increased disc pressure that pushes the disc material beyond its border. Because this is a pressure related event, activities that increase pressure like bending/flexing the spine, coughing, laughing, sneezing, and even evacuating the bowels all can cause an increased level of pain. Luckily, Harry does not have the “red flags” of disc herniation like loss of bowel or bladder function (can’t go, or leaks), new bilateral limb pain (both arms or both legs hurt), or profound weakness. If he had these danger signs, he should have gone to the doctor immediately. A doctor can offer a complete nervous system examination that includes the evaluation of reflexes, muscle strength, sensation. All of the exam findings offer clues to the cause. However, there is only one definitive way to diagnose a disc herniation, an imaging study like the MRI. Typically, without the “red flags”, a MRI is not necessary unless the symptoms persist for 12 weeks (remember that number for later). A MRI can clearly show the borders of the disc and what those borders are doing. Other tests can help to add pieces to the puzzle like the electrodiagnostic study which tests for substantial, measurable nerve damage. Most of the times, none of these test really make a difference in the recovery from a painful disc herniation.
Poor Harry has been struggling for a week with his neck pain. After searching for information on the internet, he is pretty sure that he has a herniated cervical disc. His wife wants him to go to the doctor, but it is tax season and there is no time for that. He hopes that this pain will just pass.
Spinal disc herniation is more often than not a recoverable injury. Discs heal. Nearly 85% of people with disc herniations have good or excellent outcomes. Also remember that some people have herniations and have no pain. The common misconception is that disc herniations require surgery. Sure, some herniations cause those “red flag” nerve problems that need surgery. But, most disc issues progress towards resolution naturally. A majority of herniations resolve within 12 weeks. That is why MRI’s are not considered necessary until the 12 week post-injury point. After that, with strengthening and education, some herniations take up to 6 months of healing time. Only the most severe herniations that cause significant nerve damage can take up to a 1 year for recovery because nerves take a little longer to repair. The entire healing process depends on the health of the individual. Fortunately, Harry is healthy and doing the right thing by resting a little bit and controlling the inflammation. By allowing nature take its course, he is highly likely to fully recover. Recovery and healing happens, naturally. For this reason, disc herniations do not have to be scary.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.