What is
Disc herniation occurs when an intervertebral disc
degenerates and deteriorates, causing the inner nucleus to leak into a weakened
area on the outside of the disc.
The weak point in the outer nucleus of the intervertebral
disc is directly below the spinal nerve root, so a herniation in this area can
put direct pressure on nearby nerves or the spinal cord.
Therefore, herniated discs are sometimes a cause of
radiculopathy, which encompasses any disease that affects the nerve roots of
the spine.
Dr Ashu Consul, best orthopaedic in Dwarka,
consultant at Venkateshwara Hospital, adds that, initially, herniated
discs can be confused with the following pathologies: “piriformis syndrome,
facet arthropathies, deep gluteal syndrome, peripheral neuropathies, muscle
trigger points and, in more severe cases, tumors”.
Causes
The vertebrae of the spine are separated by discs that
cushion movement and leave space between the vertebrae. In the same way,
they allow their movement, which makes it possible to bend down or stretch out.
In addition, the vertebrae of the spine protect the
spinal cord that comes from the brain and runs down the back to the lower
back. The discs fulfill a very important function of cushioning and
distribution of loads and any damage to them can be serious if not treated
quickly.
The disc can move out of place, that is, herniate, or
rupture due to injury or stress. This can cause excess pressure on the
spinal nerves resulting in pain, numbness or weakness in the patient.
Normally, herniated discs are located in the lumbar
region, with the second most affected area being the cervical discs (the neck).
Symptoms
A cervical disc herniation can cause pain in the neck, which
in turn can radiate to the arm, shoulder, or can cause numbness or tingling in
the arm or hand. Sometimes the pain can be dull, constant, and difficult
to locate.
In addition to this pain, the symptoms of herniated discs
are the following:
- The
first sign that the patient has a herniated disc is pain in the arms
and neck. If numbness or tingling occurs it may indicate that the
problem is more serious.
- Typically,
the patient complains of sharp, cutting pain, and in some cases,
there may be a prior history of episodes of localized pain, present in the
back and radiating down the leg.
- The
episode of pain may come on suddenly or be heralded by a tearing or
snapping sensation in the spine.
- When
the pain starts slowly, it can worsen after the patient spends a long time
sitting, standing, at night, when sneezing, coughing or laughing.
- Weakness is
also a common symptom that affects the leg or arm and may require
excessive effort to move them.
- Usually,
the numbness or weakness goes away over a period of several weeks or
months.
Prevention
According to Orthopaedic in Dwarka,
“exercising regularly and appropriately is important. Also avoiding
leading a sedentary lifestyle, being overweight and smoking helps prevent this
type of back pathology. Finally, avoid unnecessary risks such as
lifting heavy objects, improperly bending or twisting the lower back, or
sitting or standing in the same position for many hours and in an
unergonomic way.
Types
There are three degrees:
- Disc
protrusion: when the nucleus pulposus has not yet come out of the
annulus fibrosus, it is therefore weaker and gives way in its
structure. This is the first stage of a herniated disc.
- Disc
herniation: the material of the nucleus pulposus is ejected from the
limits of the annulus fibrosus.
- Disc
extrusion: the exit of the disc material is violent and breaks the
posterior common vertebral ligament, leaving free fragments in the
vertebral canal.
Diagnosis
To diagnose a herniated disc, the orthopaedic
doctor in Delhi will carry out a medical examination of the
spine, arms and lower extremities. Depending on the region where the
patient's symptoms are located, the orthopaedic in Delhi
will look for possible numbness or loss of sensitivity.
In addition, he will test your muscle reflexes, which
may have been affected and slowed down or even disappeared. He will also
study the patient's muscle strength and the shape of the
curvature of the spine.
On the other hand, the patient may also be asked to sit,
stand or walk, bend forward, backward or sideways and move the neck, shoulders
or hands.
Diagnostic tests that can verify the existence of a
herniated disc are:
- An electromyography that
will determine which nerve root is affected and where it is compressed.
- A myelography to
specify the size and location of the hernia.
- An MRI that
will show if there is pressure on the spinal cord.
- Finally,
an X- ray of the spine may also be performed to rule out
other injuries that cause cervical or back pain.
Treatments
The first treatment given to patients with this condition
is short rest and pain medication, followed by a period of physiotherapy
session with physiotherapist
in Dwarka. In most cases, almost immediate recovery occurs,
but in other cases medication or injections may be required.
In the case of corticosteroids, they are usually
administered, above all, non-steroidal anti -inflammatory drugs to
control pain and also muscle relaxants.
Injections into the area of your back where
the herniated disc is located can help control pain for a few months. In
addition, these injections greatly reduce the swelling of the disc.
The last option is microdiscectomy, considered
as the surgery that is used to relieve pressure on the nerve root and allow the
nerve to recover more effectively. This type of intervention does not
entail great difficulty, since it is usually enough with a small incision and
one night of admission.
Regarding the therapeutic approach to herniated discs, Orthopaedic in West Delhi
states that "one of the most important advances has occurred in the
increased precision of diagnostic tools, which has made treatment much
more effective and specific, both in management conservative as in the
surgical. From the surgical point of view, the trend is towards minimally
invasive, what we commonly know as microsurgery, so that the tissues
suffer the least negative impact after the surgical intervention”.
At what age do herniated discs usually appear?
“Disc herniation can appear at any age, since its
causes are multifactorial. Although, it begins to be more frequent in
the range of 30 to 50 years of age. And they are more prevalent after
the age of 50, where it is estimated that more than 80% of the population
begins to show disc degeneration”, says orthopedic in Delhi.
