Herniated Disc: Everything You Need to Know

You might think of "the spine" as one solid-but-flexible piece, but it actually consists of small moving parts that all have to work in concert for proper mobility. Sometimes, though, that harmony has a few players who are way out of tune—namely your discs, the cushion-like pads between your vertebrae. When they become damaged and encroach on nerve roots branching off the spinal cord, that’s when they can strike the wrong note—maybe even a painful one.

Also known as slipped discs or ruptured discs, this is a relatively common condition that can occur anywhere along the spine but is most likely to affect the lower back or neck.

You might not feel much from a herniated disc—in fact, some people don't even feel it and never know it's happening until they get imaging done for another reason, like trauma to the back—but for some people, that slipping presses on adjacent nerves. That can definitely seem like a violin screech in an otherwise harmonious concert.

"It's usually not herniation itself that's problematic, or that sends someone in to see a doctor," says Neel Anand, M.D., professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles.

The problem is mainly when some part of the disc compresses nerves.

“That's when there's pain and loss of mobility, and those are both major issues that need to be addressed,” Dr. Anand says.

Your doctor may recommend physical therapy, medication, and/or surgery.

Spinal discs separate each individual vertebra and soak up shock. Without them, the bones in your spine would grind against each another, and you'd be unable to absorb the impact of trauma and body weight.

More than just protective, these cushions also give the spine flexibility, making movements such as twisting and bending possible.

Like yin and yang, discs are both soft and hard at once. There’s a tough outer layer, called annulus fibrosus, and a soft, gel-like center, called nucleus pulposus. Fibers on the outside of each disc helps them attach to vertebrae and stay in place.

If the strong outer layer of the disc ruptures, the gel-like center can “leak” into the spinal canal: the passage that contains the spinal cord and spinal fluid. Pain strikes when that gel and potentially part of the outer disc and inner gel presses against the nerve roots that run along the spinal column.

The result can be intense pain in your back, along with weakness in an arm or leg. Numbness can also occur, since the nerve signals are being blocked. Making it all more troublesome is the fact that the gel can release a chemical irritant that may contribute to nerve inflammation and pain.

Age

Age is a major contributor to disc herniation. Over time, your spinal discs naturally and gradually lose fluid volume; this is known as degenerative disc disease. As the discs wear gradually, microscopic cracks or tears can form on the outer surface, creating an escape route for the gel-like interior.

Dr. Anand puts it this way: "Degeneration is [the cause] we see most often. Think of a car tire, where you have radial fibers on the outside. Over time, you get tiny tears in that fiber from usage, and then [the tears] get larger. For some people, a tear can get big enough to allow what's on the inside to come out.”

Trauma

Trauma is the second most common cause of a herniated disc. You can overstress a spinal disc when you twist or lift something heavy. A disc can rupture during high-impact trauma, too, such as a car accident or fall.

You may also be more likely to have a herniated disc if you’re obese, or if other people in your family have had it, as research suggests it can run in families.

Disc herniation can happen in any part of the spine, but it’s most common in the lower back and neck (the lumbar and cervical spine). These are the flexible parts of the spine, unlike the middle of your back (the thoracic spine), and because they allow for the most movement, they also have the most wear and tear, causing that lost fluid volume.

If the herniation is minimal, or it's not pressing on a nerve, you might have no symptoms at all. Dr. Anand says many people live with some degree of herniation.

For those who have herniations that do affect nerves, pain can be severe and unrelenting. It's typically felt on one side of the body and may radiate to an arm (if the herniated disc is in the neck) or leg (if a lumbar disc is herniated; sciatica is an example).

Other signs and symptoms of a herniated disc include:

• A dull ache on one side of the body

• Pain when you cough, sneeze, or move into certain positions

• Numbness, tingling, or burning sensations, usually from a compressed nerve.

• Pain that's worse with sitting, but standing, walking, and bending can worsen the symptoms as well

• Muscle weakness or spasm that may affect your ability to lift or hold items

• Balance issues or limping due to weakness and/or pain

• Slow reflexes

• Difficulty getting up from a seated position

• Inability to remain in one position for an extended period of time

• Poor posture

• Loss of bowel or bladder control (which can indicate cauda equina syndrome, a medical emergency)

To figure out if you have a herniated disc, you can see an orthopedist or your primary care doctor. A herniated disc will be suspected if low back pain is accompanied by radiating leg pain.

Your doctor will likely have you do the “straight leg raise test.” Lying down, you’ll lift one leg straight up. If you have a herniated disc compressing on a nerve, that movement will increase the compression and cause pain throughout that leg. Your doctor will also ask about numbness, weakness, and slow reflexes.

From there, imaging studies are usually ordered. You may need:

Magnetic Resonance Imaging (MRI)

This technology reveals the spinal cord, surrounding soft tissue and nerves. It is the best imaging study to support the diagnosis of a herniated disc.

Nerve Conduction Studies (NCS) and Electromyogram (EMG)

These studies use electrical impulses that measure how much your nerves might be affected by compression from a herniated disc. NCS and EMG are not routine tests to diagnose herniated disc, and are only used if you have symptoms of nerve trouble like numbness and radiating pain. These studies are typically only used if MRIs and a physical exam are inconclusive and your doctor thinks other conditions are a possibility.

X-Rays

They’re not the imaging medium of choice because soft tissues such as discs and nerves are hard to capture with this technology. However, they may be used as an initial tool to rule out other disorders such as bone spurs or fracture.

Most people who have herniated discs respond well to conservative treatment and do not require surgery.

"Often, there won't be one single strategy to address herniation in a non-surgical way. You'll be encouraged to adopt some healthy lifestyle practices along with targeted treatment like physical therapy," says Nikhil Jain, M.D., clinical spine surgery fellow at University of Louisville School of Medicine. "Even if genetics is playing a role, there's a great deal you can do to improve spinal function."

In addition to physical therapy and pain-relieving medications as recommended by your doctor, these are a few things you can do to feel better.

• Get to a healthy weight. Excess weight can worsen compression in the spine, so dropping some pounds may alleviate pain.

• Quit smoking. In addition to contributing to chronic disease, smoking is a major risk factor for degenerative disc disease, particularly in the lower back and neck.

• Do low-impact activity. Bed rest may be tempting, but it can lead to more muscle stiffness and weakness.

• Do core exercises. You’ll want to strengthen your "girdle" of core-muscle support in your abdomen and lower back. Your doctor or physical therapist can recommend moves that are safe for you.

• Consider an epidural steroid injection: Your doctor may suggest this type of injection, called an ESI, as a minimally invasive procedure that can reduce inflammation in the affected nerve. Relief usually lasts about three months, which may be enough for your back to heal so you don't need a follow-up injection.

If you've tried non-surgical strategies and you still have symptoms after three months, surgery may be a good option. It’s often a simple outpatient procedure that takes less than an hour.

"Spinal surgery has come a long way, even in the past few years. Unless there's a concern, most people go home the same day, and usually in just a few hours after the procedure," Dr. Anand says.

There are two main surgical procedures for a lumbar herniated disc.

Microdiscectomy

This procedure removes portions of the disc as a way to relieve the pressure on the spinal column. Microdiscectomy is sometimes called microdecompression.

Laminectomy

In a laminectomy, a portion of the vertebral bone is removed. This creates more space for the spinal cord and nerves, so they aren't being compressed.

There are two additional options for herniated discs in the cervical spine (the neck)

Anterior Cervical Discectomy and Fusion (ACDF) or Cervical Disc Replacement (CDR)

ACDF or CDR are both surgeries that remove the offending disc and insert either a bone graft (ACDF) or artificial disc (CDR) to stabilize the area.

Microlaminoforaminotomy

In this surgery, your surgeon will remove a small piece of bone from your vertebra to create more space for the pinched nerve(s).

After either surgery, most patients feel relief from symptoms like pain, numbness, and weakness right away. However, it could take several weeks or months for the nerves to fully heal.

Given that there’s a wide range of good options to relieve pain from a herniated disc, you shouldn’t put off a doctor visit about your back pain.

"The longer you wait, the more difficult it will be to get you back on track," says Dr. Anand. "If you're hurting and not able to live your life the way you want, see your doctor, because there is a lot we can do to help."

What causes a herniated disc?

Normal aging of spinal discs, trauma, overexertion, obesity, and genetics can all play a role. In many cases, there is no single event that causes a herniated disc.

What happens if herniated discs aren’t treated?

That depends on how your herniated discs affect you. If you have no symptoms, you may not need treatment. If you have symptoms, they could get worse without some treatment. In part that’s because you may try to move less, which could weaken the back muscles that support your spine.

Can herniated discs be treated without surgery?

Many people find relief without surgical intervention. Lifestyle changes, including gentle activity that strengthens back muscles, can help quite a bit. Your doctor may also suggest over-the-counter pain relievers and physical therapy.

Is a herniated disc the same as a slipped disc?

Yes, they're the same. Another term you might hear is ruptured disc.