Herniated Disk - Symptoms, Causes, Prevention and Treatment

Disc prolapse refers to the problem with one of the discs (rubbery cushions) sitting between the vertebrae (bones) that make your spine. These cushions allow you to move and bend with ease. When one of these discs leaks or tears, it is called disc prolapse. Most often, the condition occurs in the lower back. Disc prolapse is also known as a Herniated, Slipped, Ruptured, or Bulging Disc. 

The symptoms of disc prolapse vary depending on the location of the problem in your spine

Disc prolapse in the back

1. Sciatic pain shoots down to one side of the buttocks into your leg and sometimes the foot
2. Back pain
3. Muscle weakness
4. Tingling or numbness in the legs and feet
5. Urinary Urgency or retention

Disc prolapse in the neck

1. Neck pain
2. Pain near your shoulder blades
3. Pain that travels down your shoulder and arm to sometimes your hands and fingers
4. Numbness or tingling in arms
5. Pain that escalates when turning or bending your neck
6. Weakness in grip/hands

A spinal disc contains a soft, jelly-like centre (nucleus) enclosed in a tougher, rubbery exterior (annulus). Disc prolapse occurs when some nuclei get pushed out through a tear in the annulus. This soft jelly material may press on nearby spinal nerves. Factors that contribute to a rupture in the disc include:

1. Excessive weight
2. Ageing
3. Strain from sudden lifting or twisting
4. Repetitive motions
5. Weak muscles

The risk factors of disc prolapse include:

1. People aged between 30 to 50
2. It affects men more than women
3. Being overweight
4. Physically demanding jobs
5. Genetics
6. Sedentary lifestyle
7. Smoking
8. Being seated for long periods in the same position

It may not always be possible to prevent disc prolapse. However, you can reduce your risk by following these prevention tips:

1. Maintain a healthy weight
2. Maintain a good posture
3. Use proper lifting techniques (bend at the knees while keeping your back straight)
4. Do not remain seated for long times - take stretch breaks
5. Avoid wearing high-heeled shoes
6. Exercise regularly
7. Quit smoking

For the diagnosis of disc prolapse, your doctor will conduct a physical exam. During the exam, you will be asked to lie flat and move your leg in several positions to determine the cause of the pain. Furthermore, he/she would check your back for tenderness. Apart from a physical exam and medical history, your doctor may conduct a neurological test to assess your walking ability, muscle strength, reflexes, and sensation. Your provider may also order other tests, which include:

1. X-rays: X-rays do not detect disc prolapse, but they can rule out other causes of back pain such as a broken bone, infection, or tumour. 
2. CT Scan: A CT scan creates cross-sectional images of the spinal column and the structures around it. 
3. MRI: It uses radio waves and a magnetic field to determine the location of the disc prolapse and analyse the affected nerves. It is investigation of choice
4. Myelogram: This is done before a CT scan. During the test, the doctor injects a dye into the spinal fluid. It is used to show the pressure on the spinal cord and the narrowing of the spinal canal. It is not recommended these days
5. Nerve Conduction Study: The doctor places electrodes on your skin in this test. A small current is passed through the nerves to measure the electrical nerve impulses and assess the functioning of the muscles and nerves. 
6. Electromyography (EMG): In this test, the doctor places small needles in various muscles to evaluate their electrical activity when contracted and at rest. The test determines the nerve that gets affected by disc prolapse. 

How to Prepare for Doctor Consultation?

While preparing for a doctor consultation, make sure to:

1. Take a prior appointment.
2. Make a list of the symptoms you are experiencing and all the medications you are taking.
3. Note down your questions for the doctor.
4. Ask a relative to accompany you. 

Here are some questions you can expect from your provider:

1. When did your symptoms begin?
2. Were you lifting or pulling something the first time you experienced the symptoms?
3. Does the pain keep you from engaging in activities?
4. Does anything improve or worsen your symptoms?
5. Do you feel a tingling sensation or weakness in your arms or legs?
6. Is the pain interfering with your routine activities?
7. Does coughing or sneezing worsen your pain?
8. Are there any noticeable changes in your bowel or bladder habits?
9. What medications do you take?

Here’s what you can ask your doctor about disc prolapse:

1. What is the cause of my pain?
2. For how long do I need to rest?
3. Which activities should I engage in?
4. What pain medications do you recommend?
5. Are there any exercises that can relieve the pain?
6. How can I prevent its progression?
7. Why is surgery needed? 
8. Can it be managed without surgery?
9. If surgery, what are the risks?
10. Which cortisone injections can relieve my pain?

Treatment for disc prolapse usually involves a conservative approach, i.e., modifying activities and taking pain medications. The conservative treatment successfully relieves symptoms within a few days or weeks in most people. Your doctor may recommend the following treatment options based on your condition:

Medications

1. Non-prescription pain medications: If you have a pain ranging from mild to moderate, your provider may recommend non-prescription pain medications such as Tylenol, Advil, etc. 
2. Muscle relaxants: These may be recommended if you have muscle spasms. 
3. Neuropathic drugs: Gabapentin, duloxetine, pregabalin, or venlafaxine to reduce nerve pain. 
4. Cortisone injections: If the pain does not improve with oral medications, the doctor may recommend a corticosteroid injected into the area around the spinal nerves. It reduces the swelling and inflammation of the nerve caused by disc prolapse. 
5. Physical Therapy: Physical therapy is another treatment option that your doctor might recommend to relieve pain. A physical therapist teaches you exercises and positions to minimise pain, relieve pressure on the nerves, loosen tight muscles, and improve circulation. 

Surgery

In rare cases, people with large disc prolapses require surgery. When the disc prolapse injures the nerves to the bowel or bladder, you may require emergency surgery. For non-emergency cases, your doctor may suggest surgery when other treatments fail, and your symptoms do not improve after six weeks. The surgical options for treating disc prolapse include:

1. Laminotomy/ laminectomy: The surgeon removes a part or most of the lamina (vertebral arch) to reduce pressure on the spinal cord or nerves and relieve pain. 
2. Discectomy/ microdiscectomy: The surgeon removes the damaged portion of a prolapsed disc in the spine to relieve pressure on the nerve root. It is most commonly used to fix a disc in the lower back. The surgeon may use a smaller incision and special instruments to achieve the same results in some cases. This procedure is known as microdiscectomy. 
3. Artificial disc surgery: In this procedure, your damaged disc is replaced with an artificial disc made of plastic and metal. 
4. Spinal fusion: The surgeon fuses two or more vertebrae in your spine to eliminate movement between them. This is done with the help of bone grafts from another part of the body. 

Home Remedies

Besides taking medications, your doctor may recommend some home remedies, which include:

1. Apply cold packs or gentle heat for relief and comfort.
2. If you experience severe pain, rest for a day or two; however, do not rest for long periods to avoid stiffness. 
3. Resume your activities slowly.

The lower end of the spinal cord is the sack of nerve roots called cauda equina. In rare cases, disc prolapse can compress the complete spinal canal, including the nerves of the cauda equina. In such cases, you may require emergency surgery to prevent permanent weakness or paralysis. If left untreated, disc prolapse can lead to the following complications:

1. Worsening symptoms
2. Loss of bladder or bowel control
3. Saddle anaesthesia (loss of sensation affecting the back of legs, the inner thighs, and around the rectum)
4. Irreversible Weakness/Paralysis