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Herniated Disc

Herniated Disc

INTRODUCTION

The spinal column extends from the base of the skull to the pelvis. It is composed of thirty-three vertebrae. These vertebrae allow motion and render flexibility while the bones, ligaments and muscles provide stability. The spinal column is designed as such to enable the performance of day to day activities – motion for the neck and back, and support for the upper body weight.

In between the individual vertebrae bodies are discs. It appears to be in a stacked position wherein the discs serve as protection to keep the neck and back mobile while minimizing friction between vertebrae. The disk has a tough exterior (annulus fibrosus) with a soft gel in the middle (nucleus pulposus). The outer part is made up of concentric sheets of collagen fibers. Both are composed of water, collagen and proteoglycans but fluid content is much higher in the inner core. Due to a variety of reasons these discs can degenerate causing the inner core to go through a tear in the outer core. When this happens, the disc can inflame nearby nerves, the outer core and the spinal column, which in turn causes pain, numbness and other excruciating results. This condition is what we call a Herniated Disc.  


CAUSES

As mentioned above, there are a variety of reasons resulting to one developing a Herniated Disc. The following are possible causes:

1. Aging

The most common cause for disc herniation is the natural process of aging. Overtime the discs degenerate – decreasing in water content rendering it brittle and less flexible – such can contribute to the formation of a leak out of the outer core of the disc when even non-strenuous motion is involved. The discs also begin to shrink as part of the aging process

2. Spine Trauma

While normal aging happens overtime, spinal trauma is a sudden change resulting from an injury in the spinal column that causes one to have a Herniated Disc. Usually, that kind of injury comes from high-impact sports. However, chronic injuries can also eventually result to a disc herniation such as jobs that constantly expose the spine to strain and pressure, i.e. heavy weight lifting.  

3. Overweight

The spine is responsible to support the additional weight of the body specifically in the abdominal region. The vertebrae is compacted from the added weight which in turn congests the discs in between. Hence, overtime the pressure it places on the spine can eventually result to damages such as a Herniated Disc.

4. Poor Lifting

Constantly lifting heavy weight objects can cause strain in the lower back and accumulate small tears in the discs which eventually result to a rupture in the disc.

5. Smoking Habits

Smoking can release toxins in the body which can affect the discs in the spine. It also impedes the circulation of important nutrients to keep the spine healthy.

6. Poor Nutrition

As aforementioned, there are certain nutrients needed to keep the spine healthy. Poor nutrition can deprive the spine of those essentials. Also, poor nutrition is one of the causes of bad weight gain. Hence, it too can eventually lead to a Herniated disc condition.

7. Genetics

It’s possible that a family has a history of spine diseases and conditions such as a Herniated disc which increases the chances of developing disc herniation.


SYMPTOMS

The symptoms of a Herniated disk will vary depending on the cause, position of the disc in the spine and severity of the herniation. Also, if whether or not a nearby nerve has already been inflamed.  It commonly occurs in the cervical and lumbar spines because this is the part that inhibits more movement and support for the weight of the upper body. It’s also possible for the herniation not to inhibit any symptoms at all. The following are example of the many symptoms that occur due to disk herniation:

  • Unexplained muscle weakness in the neck
  • Numbness in shoulders, arms and hands
  • Pain when walking
  • Tingling or burning sensations in the back
  • Upper back pain
  • Lower back pain
  • Back stiffness
  • Pain in legs
  • Numbness in legs
  • Muscle weakness of lower extremities
  • Incontinence of bowel and bladder

Most of the symptoms can be identified with the part of the spine that has been affected. In the cervical spine section, symptoms usually appear in the arms, hands, head and neck. For symptoms that occur in the thoracic section of the spine, it usually happens in the chest, ribs, shoulders and stomach. Lastly, for the lumbar spine section, it is usually found in the lower extremities.

However, if a nerve has been affected then the symptom usually appears in the part of the body connected to the affected nerve. It is best to consult a doctor to properly identify the cause of the symptom.  


RISKS

Aging

It’s the inevitable scheme of our bodies that as we grow old, some things will deteriorate. Our spines with all the discs and vertebrae are not an exception. Aging is the most common cause for having Herniated disc condition. Those discs will eventually weaken with age. They tend to get dehydrated, brittle and thin. They’re meant to absorb the shock, acting like cushions for the spine, but they tend to lose their elasticity overtime which increases their overall vulnerability.

With a certain amount of pressure, a rupture can take place in the outer core where the inner core, the more gel-like substance pushes out of the exterior. This condition is what we call a disc herniation. The herniated disc can then inflame or irritate spinal nerves which can result to excruciating symptoms.

Overweight

Abnormal weight gain is generally accepted to cause plenty of health problems. Part of these problems can be associated with the spine. The spine is primarily responsible for supporting some of our body weight particularly in the upper region. The added weight causes added stress on the spinal discs. There are plenty of spine conditions that can result from obesity, and one of them is the Herniated disc condition. With age, the discs in between the vertebrae in our spine wear out. They lose their elasticity and capability to minimize friction and absorb shock from the body’s motion and weight. Increased weight gain means increased pressure on the spine, and in the discs. As they are already more susceptible to damage with time, over weight increases even more its likelihood for damage. A disc herniation happens once the inner gel-like substance (nucleus pulposus) pushes out through a rupture in the outer wall (annulus fibrosus). This tends to irritate the outer wall, the spinal column and worse, spinal nerves rendering localized pain and other symptoms.

Smoking

Smoking is dangerous to one’s health. The diseases caused by smoking are usually related to the lungs. However, smoking can also have negative effects on the spine. One of it is Herniated disc condition. The toxins that are released from smoking also extends to the spine. The discs in the spine need certain essential nutrients to keep them healthy which helps them from deteriorating faster. However, the toxins released from smoking tend to interfere with the supply of these nutrients to the discs. Hence, complications are more likely to occur. In disc herniation, the inner substance (nucleus pulposus) of the disc tends to push out of a rupture in the outer wall (annulus fibrosus). This happens due to many reasons, one most common is aging. However, the likelihood of a herniation is increased when the circulation of the nutrients for the disc is impeded. So the worse the smoking habits are, the worse it will be for the spine.


PREVENTION

A herniated disk is a result of the rupture of the outer lining (annulus fibrosus) of the disks that allow the inner substance (nucleus pulposus) to push through, not only irritating the outer wall but possibly also the surrounding spinal nerves. These discs serve as cushions for the spine as the spine is made of vertebrae that work together to allow movement for the body. They appear in a stacked-like position since the discs are located in between individual vertebrae. Hence, they are constantly exposed to pressure as our body moves and also from support for our body weight. There are many causes for a herniation to occur but all of them simply contribute to the deterioration of the discs either from decapitating its nutrient cycle, increasing pressure or exposing it to forceful shocks. In many cases, there are plenty of ways to prevent a herniation from happening or delaying its development.

The prevention methods vary from life-changing habits and small everyday decisions. It doesn’t cost a lot of money but rather discipline and control.

Posture Improvement

Improving one’s posture isn’t just a beauty tip but a medical fact that it aids the spine with regards to weight distribution. The body’s weight is one of the main factors that contribute to the pressure of the discs in between the vertebrae of the spinal column. The proper alignment of the spine allows weight supported by the spine to be transferred to some of the core muscles. Holding a proper posture will delay the development of disk herniation if not fully impeding its progress.

Healthy Diet

While a disk herniation is most likely inevitable to avoid with aging, keeping a well-balanced diet delays the development. Being overweight is one of the risk factors of disc herniation. The added weight increases compression of the spine that can contribute to a rupture occurring in the disc. Hence, avoiding those unhealthy pounds by maintaining a balanced diet is key to delaying the development of disc herniation.

Exercising and Stretching

Just as proper posture improves core muscles, so does exercising strengthen the muscles to remove unwanted pressure from the spine. There are various stretches and exercises that decompress the spine. Therefore loosen the pressure from the discs by allowing more space in between vertebrae. It is best to consult an expert to ensure that the exercises do not aggravate the pressure on the spine.

STOP Smoking

Basically, smoking impedes the nutrient cycle of the discs in the spine because of the toxins it releases in the body. As the discs are already prone to deteriorate overtime, cutting off its nutrient supply will increase the vulnerability of the discs. Hence, stopping the habit allows the normal circulation to flow, providing the essential nutrients to the spine therefore strengthening the discs to avoid tears from occurring that lead to herniation. Depending on the gravity of the habit, there are various things one can do to quit smoking.


TREATMENT

Treatment for disc herniation varies depending on which part of the spine is affected and the gravity of the condition. There is a long range of treatments from conservative care to surgical procedures. It is best to consult a physician to ensure the appropriate treatment as there are other factors to be considered such as a patient’s medical history. Also, for a complete diagnosis to take place, the physician will order the necessary imaging or nerve tests based on the symptoms. Some patients may need immediate surgical attention while others may only need beneficial lifestyle changes.

 

(1)   CONSERVATIVE TREATMENT

Once the physician consultation has been conducted and no surgical procedures were recommended, usually a conservative treatment is applied to reduce the pain caused by the disc herniation. It is usually a combination of certain treatments and medications. Conservative treatments are given to those with less serious conditions. Eventually patients can be relieved from pain from succession of treatments and/or therapies. Just like how exercising and stretching prevent or delay the development of disc herniation, these treatments can strengthen muscles around the spine and loosen the compression to remove the pressure from the affected disc.

 

The following are examples:

 

·       Medication

Usually, nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics (pain relievers) which are over-the-counter medicines are administered to reduce pain and other symptoms such as burning sensations, numbness and muscle weakness. When the inner core (nucleus pulposus) pushes outa tear in the tough exterior (annulus fibrosus), it can inflame nearby spinal nerves. NSAIDs will fully or partially remove the inflammation to alleviate the excruciating symptoms. However, patient’s whose medical history involves cardiovascular or gastrointestinal conditions will not be advised to take these medicines.

 

Narcotics – mostly, codeine or an oxycodone-acetaminophen combination – are given once the over-the-counter medications do not relieve the patient from the pain and other symptoms. However, these medications are only administered at a certain period of time since they can be highly addictive and can cause drug abuse complications for the patient.

 

·       Physical Therapy

Physical therapy decompresses the spine and renders surrounding muscles stronger to alleviate the pressure that causes the pain. It can be halved into two categories – passive and active. It is usually a combination of both to ensure optimal recovery.

 

The following are examples of passive therapy:

o   Hot and cold Therapy

o   Hydrotherapy

o   Iontophoresis

o   Deep Tissue Massage

o   TENS Units for Electrotherapy

 

The aforementioned treatments are responsible for realigning and    decompressing the spine resulting to less pressure on the discs in between individual vertebrae which makes more space in between them.

 

Active therapy likewise alleviates future compression by strengthening core muscles around the spine to aid in supporting the weight carried by the spine. From the name itself, it involves physical effort into an activity. It can be performed by the patient alone or with mechanical assistance.

 

The following are examples of active therapy:

o   Core strengthening exercises

o   Stability exercises

o   Flexibility stretches

 

·       Chiropractic

This is a manipulative treatment for the spine for misaligned parts, benefitting mostly those with low-back pain. It is a hands-on therapy and spinal adjustment is the core of chiropractic care. However, there have been some reports on fatal side effects such as stroke specifically those done in the neck.

 

·       Acupuncture

This treatment is mostly known for moderate pain and is effective in modest herniated disc situations. It uses the technique of inserting needles in the body that to fuel specific points in the body. It is a traditional Chinese medicine.

 

·       Yoga

For some people, yoga works to treat the localized pains from disc herniation. It’s composed of breathing exercises, meditation techniques and physical activity.                       

Although most of these conservative treatments helped in alleviating painful symptoms caused by disc herniation there remains an ambiguity in some of the conservative treatments such as acupuncture, chiropratic treatment and herbal medications. There is still an ongoing research regarding the safety of these methods.

(2)   SURGICAL TREATMENT

Usually, conservative treatments are the initial approach to treating a herniated disc if immediate surgical operations are not needed. However in some cases even after conservative treatments, the symptoms still persist, then a surgical treatment is considered. Traditionally, the method of treatment is open back surgery, but there are other minimally invasive surgeries that has less post-surgical pain and recovery.

 

There are different types of procedures one can have in a surgery. Based on the patient’s circumstances and the gravity of the herniation, the surgeon will choose which procedure is best suited for their situation. There are two common procedures involved:

 

o   Discectomy – procedure that removes partially if not all of the herniated disc removing pressure on the spinal cord or nearby inflamed nerves. After which, the vertebra is fused together for stability with the use of implants.

 

o   Laminotomy – procedure that partially removes laminae (thin plates of bone that are in a shape of an arch around the spinal cord to protect it) to relieve the compressed nerve by enlarging the spinal canal.

 

The aforementioned procedures can be done in different kinds of surgery.

 

·       Open spine surgery

The first and more traditional way to perform the procedures is through the open spine surgery. The surgery involves large incisions in the abdomen, neck or back. The incision is about six to eight inches that cuts through muscles and tissues that surround the spine to get to the infected area of the spinal column. Then, it involves the removal of the disc often partially. Rarely, in some cases is the disc fully removed. After which, the vertebrae are then fused together with stabilizing metal implants or bone grafts.

 

The recovery process can take several months. This operation however has a high risk for infection, excessive bleeding, affected muscles from incision and failed back surgery syndrome (FBSS). FBSS is the continuing occurrence or worsening of symptoms after the surgery and may even require further surgery.

 

The upside of this procedure is that it has been tested for so many years. Professionals will have high level of expertise because of much greater experience in this kind of surgery. It’s much easier for doctors to have a clear visual on the structure of the spine. Also, only one large incision is needed so the surgeon can perform multiple operations on the spine. Hence, this is procedure is much more suitable for those with multiple spine problems that need operation.

 

·       Minimally invasive surgery

This is an outpatient procedure. Unlike the open spine surgery it only makes a small incision in the neck or back. Then, multiple tubes are inserted careful not to affect the muscle and tissues but to softly push them aside. These tubes serve as funnel through which surgical tools and a camera are used to access the herniated disc. Unlike the open back surgery, the surgeon’s visual of the spine structure comes through the camera. In order to relieve the affected nerve or the spinal cord, the affecting substance and sometimes bone fragments are vaporized or in severe cases, an artificial disc is implanted to replace the herniated disc.

 

The minimally invasive surgery offers a lot of advantages compared to the open spine surgery too. It renders back muscles functional and unaffected post-surgery. Because of the smaller incision made it allows faster rehabilitation and recovery, less pain and chances for infection and minimal blood loss compared to open spine surgery. Overall, it is a lot more cost-friendly with due to minimized hospitalization and the spinal procedures itself.

 

The downside for this kind of surgery is certainly first, it allows less proper visual for the surgeons conducting the operation. The surgery renders it difficult to perform multiple operations on the spine. Because it is not the traditional method of surgery for treating herniated disc conditions, plenty of surgeons are a lot less experienced in this field. Hence, the success of the operation will greatly depend on the doctor’s specialty in this kind of surgery.

 

RECOVERY

 

Immediately after the surgery, one will feel pain due to the incision made during the operation. Usually, one isn’t able to immediately mobile as further observations will still be made. The doctor will inform the patient about the recovery period and the steps that need to be made.

 

The period of full recovery will depend upon the kind of surgery that was made. It is important to make not of these things as surgery might require time off of work. Even though one’s work may not involve physical labor, it may still take time before one can return. The recovery can sometimes take longer or shorter time depending on individual progress.

 

Recovery differs for each person. Hence, it is important to be positive and realistic about one’s progress. The key is to be dedicated to the steps the doctor have given to fully recover. Remember that just because one feels better doesn’t mean that the muscles in the body can easily take sudden strenuous activity. The purpose of the recovery is gradual recovery to ensure optimal function for the spine and the muscles.

 

Although surgery will remove the herniated disc to alleviate pain or other symptoms, after surgery recovery is still essential to render the spine fully-functional and healthy. It generally might involve a series of treatments to ensure a successful recovery.

 

Rest – The period of hospitalization depends on the kind of surgery that was performed. If an open spine surgery was conducted then, a patient would usually take more time recovering in the hospital for a couple of days. If a minimally invasive surgery was performed then there usually is no hospitalization involved. However, the patient will be asked take some rest at home. This includes avoiding activities that could place heavy pressure on the spine such as bending, lifting – especially heavy objects – and twisting the torso. It can help improve the healing stages of the spine during recovery period.

 

Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs) is usually administered post-surgery to ease pain that come from inflamed areas in the spine.

 

Physical Therapy — Therapy sessions are essential. They don’t always have to be with a physical therapist but it involves low-impact exercises to help ease the spine into normal activity. Exercises should gradually increase in intensity. Physical therapists will aid in suggesting exercises that are best for the given condition.

 

·       Recovery from Open Spine surgery

While a full recovery from an open spine herniated disc surgery could take several months to a year, the recovery associated with a minimally invasive procedure is typically much faster and far less arduous. This shortened recovery is largely because minimally invasive procedures don’t require the large incisions and muscle disruption that open spine surgeries require. Just as previously mentioned above, a patient needs to stay in the hospital for several days after this kind of surgery for further care and observations. Evidently, it will take much longer to return to work and other activities.

 

·       Minimally invasive surgery

The recovery will depend upon the procedures made during the surgery – stabilization or decompression. However, they won’t be asked to stay in the hospital for several days after the surgery. In fact, this is considered to be an outpatient kind of surgery.

 

MISCELLANEOUS

 

Herniated Disc vs Bulging Disc

 

Yes there is a difference between the two! Often they are mistaken to be the same thing but they actually share stark differences. However, there are also similarities. Hence, they are often interchanged.

 

SIMILARITIES

 

o   Both of these conditions are related to the disc that lie in between the individual vertebrae in the spine giving a stack-like picture of the spine. These discs absorb shock from the movements made by the body and support made for the body’s upper weight. It minimizes friction between the vertebrae.

o   Both can lead to similar symptoms such as localized pain, numbness, muscle weakness and burning sensations.

o   Both could possibly affect nearby nerves in the spine.

o   Both have the same causes as discussed here such as aging, spinal trauma, overweight, etc.

 

DIFFERENCES

 

o   A herniated disc involves a rupture in the tough exterior (annulus fibrosus) that caused the inner gel-like substance (nuclear pulposus) to push out of the tear and affect not only the outer wall, but also the spinal cord and surrounding nerves. On the other hand, a bulging disc doesn’t involve a rupture or tear in the outer wall. It only involves a fourth r half of the perimeter of the outer wall. Hence, no inner substance has actually come out of the disc. Rather it looks like the disc is protruding from the spinal cord.

o   Although they usually produce similar symptoms, herniated discs are more severe in nature

 

WHICH DO YOU HAVE?

The first thing a person should do if they are experiencing the symptoms of a herniated or bulging disc is to consult a doctor. Because both conditions produce similar symptoms, the doctor would conduct thorough imaging test to determine which you have such as MRI or X-ray. He will also conduct physical examinations.

 

Our team will help determine whether one has a herniated or bulging disc. If one has a herniated disc condition, our team has plenty of experts that will aid in knowing the treatment that is best to be taken. It will depend on the severity and location of the herniated disc.

 

HEAT AND ICE THERAPY

Herniated disc is the result of the inner core (nucleus pulposus) of the disc pushing out through a rupture in the outer wall (annulus fibrosus). This inner gel-like substance affects the spinal cord and worse, nearby nerves in the spine. Heat and Ice therapy is one of the conservative treatments patients can make to relieve themselves of the symptoms. However, it is still best to consult a physician especially if symptoms persist.

 

o   Heat Therapy

It is also known as thermo therapy. It is especially helpful in treating localized pain caused by the herniated disc and muscle spasms. The heat helps blood flow and oxygen to relax the affected areas. It alleviates certain if not all discomforts caused by the disc herniation. One can use heat packs and hot towels.

 

o   Ice Therapy

It is also known as cryotherapy. It is especially helpful in reducing the inflammation caused by the affected nerve from the herniated disc. One can use ice or cold gel packs.

 

o   Heat-Ice Therapy

Basically, it is a combination of both heat and ice therapies. It is reported that the combination of both is actually more effective in administering relief to the pain caused by the herniated discs. However, it is dependent on the individual as some can render more pain too since inflammation cannot be suited by heat and neither can muscle spasms. 

 

 

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