Herniated disc- what do I need to know?

Our spine is made out of segments of bone linked with fibrous structures and soft tissue between them to allow the optimal balance between movement of your spine and its stability.  Generally, those soft tissue in the middle of those fibrous structure is in a disc shape, and got referred as a disc.

A herniated disc is a spinal condition where there is a malfunction in the soft tissue between your bones of your spine, usually diagnosed with a scan like X-ray or MRI.  There is varying severity of a disc issue, and we will talk about the different stages that your disc could go through.  Though it is important to note, as counter intuitive as it sound that THERE ARE NO STRONG CORRELATION BETWEEN PAIN AND IMAGING FINDINGS as shown in multiple studies, and it is widely accepted in the medical field that an imaging scan should be used together with clinical signs and examination for an accurate diagnosis.

Unless a patient shows signs of serious neurological conditions such as cauda equina, a conservative management including medication, physiotherapy and relative deloading/lifestyle modification is encouraged and imaging studies are generally not the first diagnostic options. 

Having the disclaimer out of the way, we can talk about disc herniations and its different variations.  Disc herniations happens when the structural integrity of the soft tissue in your back are compromised, and when they are protruded, they could pinch your nerves, contributing to tingling, numbness, weakness and pain in your upper or lower limbs, along with back pain or neck pain.  Here are some of its categories:

1 Disc degeneration/bulging: There is degeneration of the fibrous materials on the outside becomes weakened and the inner, jelly like part of the joint pushes outside.

2 Disc prolapse/protrusion: The outer part of the joint becomes weakened and it being pushed out due to the pressure of the inner part of the disc and could potentially irritate surrounding structures such as the nerve.

3 Extrusion: Worsening of the protrusion, where the inner, softer part of the disc brakes through the outer fibrous structure.  You may experience more severe symptoms in your back pain including tingling, numbness and pain in your limbs.

4 Sequestation: This is where the inner material of the joints comes out and fully comes out of the spinal disc.  This is often considered as a serious condition and could warrant a specialist opinion.

Most herniated disc COULD HEAL BY ITSELF especially in less severe conditions.  According to Havard health, up to 90% of pain caused by a herniated disc would resolve within six months.  For people that have back pain, the first line of treatment is generally physiotherapy or exercise physiology, using a combination of pain modulating techniques, stretches and strengthening exercise to first strengthen the surrounding muscles and ligaments, and to manage the contributing factors to pain.  

If you have any questions, please contact your local GP or book a free initial assessment to clarify questions that you may have!

References  

Sasiadek MJ, Bladowska J. Imaging of degenerative spine disease

Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN, Mazanec DJ, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. 

Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: Systematic review and meta-analysis.

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