Herniated disc: causes, symptoms and treatment options
A slipped disc is a disease of the spine in which disc tissue, in particular parts (fragments) of the gelatinous nucleus, penetrates the spinal canal through tears in the fibrous ring (annulus fibrosus) and can compress or irritate the nerve root. The vertebrae and vertebral bodies form the bony structures of the spinal column, between which the intervertebral discs lie as elastic cushions and absorb shocks. The spine consists of cervical, thoracic and lumbar vertebrae with a total of 23 intervertebral discs between them. Each intervertebral disc consists of an outer fibrous ring (annulus fibrosus) and an inner disc nucleus (nucleus pulposus or nucleus pulposus). The gelatinous nucleus provides elasticity and pressure equalization, while the fibrous ring stabilizes the disc. In the event of a herniated disc, the gelatinous nucleus can protrude outwards through a damaged fibrous ring.
The intervertebral discs act as a cushion between the vertebrae and enable mobility and cushioning. The nerve roots protrude between the vertebrae, which can become irritated or trapped if a disc herniates. In severe cases, a large herniated disc can also affect the spinal cord and lead to neurological deficits.
Slipped discs usually occur in the lumbar spine, which leads to pain in the lower back. Around 90 percent of herniated discs affect the lumbar spine. The cervical spine and thoracic spine are less frequently affected. In the case of a herniated disc in the cervical spine, the pain can radiate into the arms. The symptoms of a herniated disc vary depending on the location, usually in the lumbar or cervical spine.
There are various forms of disc damage: disc protrusion describes the protrusion of the disc nucleus without tearing the fibrous ring, while disc prolapse, disc prolapse, disc hernia and disc hernia describe the leakage of disc tissue through the fibrous ring.
Risk factors for a slipped disc include weakness of the connective tissue (b) and changes to the vertebral bodies or intervertebral discs (w b). The average age of onset is around 40 years. In Germany, around 180,000 patients are diagnosed with herniated discs every year. Complaints occur more frequently in the over-30 age group, with men being affected about twice as often as women. An estimated 1 to 3 percent of people in western industrialized countries have low back pain caused by a herniated disc. The probability of developing a painful herniated disc in the course of a lifetime is up to 5 percent. Around 30 out of 100 study participants between the ages of 20 and 30 had a bulging disc but no symptoms.
The diagnosis is usually made using MRI to check the condition of the intervertebral discs, the disc nucleus and the nerves, as early detection of spinal disorders is crucial for choosing the right treatment.
Causes and risk factors for damage to the intervertebral disc tissue
Overloading, genetic disposition, poor posture, obesity, lack of exercise and weakness of the paravertebral muscles are the main causes of herniated discs. The risk increases with age, as age-related wear and tear reduces the elasticity and water content of the intervertebral discs, thus promoting the development of a herniated disc. A slipped disc often occurs as a result of these risk factors and wear processes.
The ageing process can reduce the water content of the intervertebral disc, which leads to an increased risk of herniated discs. Lack of exercise and poor posture, particularly in office work and prolonged sitting, are common causes of an increase in herniated discs in modern times. People with certain occupations that require a lot of heavy lifting or sedentary work have a higher risk of herniated discs. An elevated body mass index (BMI) of over 27.5 kg/m² can double the risk of intervertebral disc disease. Genetic predispositions, one-sided strain and weakness of the paravertebral muscles also play a role in the development.
Typical consequences of a herniated disc are restricted movement, pain that can radiate from the back to the legs and feet, as well as sensory disturbances or paralysis in the legs and feet. In severe cases, bladder problems can also occur. A balanced diet and regular exercise can reduce the risk of herniated discs.
It is important to take regular breaks and move around during work to reduce the strain on the spine. The therapy should be individually adapted depending on the cause and severity.
Symptoms and diagnosis
Typical symptoms of a slipped disc are sudden onset of back pain, which often radiates into the leg or arm, as well as tingling, numbness, sensory disturbances, muscle weakness and signs of paralysis. Sudden, often stabbing back pain that radiates into the arms or legs is a typical symptom. The pain often increases when coughing, sneezing or pushing. Neurological deficits such as tingling and numbness (“formication”) can occur. A slipped disc can lead to a feeling of numbness in the area supplied by the pinched nerve root. A herniated disc in the lumbar spine often causes sciatica, which radiates pain into the leg. The nerve fibers and in particular the nerve root can be irritated or compressed by the herniated disc, which leads to the aforementioned symptoms. The back is the source of the pain.
Sudden disturbances of bladder or bowel function (incontinence) and the occurrence of cauda syndrome, which manifests itself in paralysis and disturbances of bladder or bowel function, require immediate medical attention. If severe pain, numbness or signs of paralysis persist, an orthopaedist or neurosurgeon should be consulted immediately.
The diagnosis is made through a combination of physical examination, medical history and imaging techniques such as MRI or CT. It is important that the doctor determines the exact location and size of the herniated disc in order to choose an appropriate treatment. The diagnosis can also be supported by neurological tests such as Lasègue’s sign or Kernig’s sign. In some cases, a myelography or discography may be required to examine the condition of the discs and nerves in more detail.
Treatment options
Herniated discs can be treated conservatively or surgically, depending on the severity and duration of the symptoms. Conservative therapy includes measures such as pain therapy, physiotherapy, heat therapy, stepped bed positioning and exercise therapy. Stepped bed positioning and exercise therapy help to alleviate pain and provide short-term relief. In many cases, conservative therapy can already achieve a good result: In around 90% of people with a herniated disc, the symptoms subside on their own within six weeks. A herniated disc can also regress on its own, which can take several weeks.
In some cases, it may be necessary to inject cortisone or other medication into the affected area to reduce inflammation and pain. A special treatment option is periradicular therapy (PRT), in which medication is injected specifically into the nerve root. Pain relief can be achieved in 67% of cases. Another innovative therapy is chemonucleolysis, in which an enzyme is injected into the nucleus pulposus to enzymatically dissolve the prolapsed tissue.
It is important that the patient actively participates in the therapy and regularly performs exercises and movements to strengthen and stabilize the spine. Rehabilitation after a herniated disc can include exercises to strengthen the core muscles, stretching and relaxation exercises and strength training.
If the symptoms do not improve significantly after six to eight weeks, surgical treatment should be considered. The likelihood of a herniated disc leading to chronic symptoms increases if the symptoms persist for longer than twelve weeks.
A balanced diet and regular exercise can also help to strengthen the spine and reduce the risk of future herniated discs.
Operative procedures
Surgical procedures such as microdiscectomy or hemilaminectomy may be necessary if conservative treatment is unsuccessful or if severe nerve damage occurs.
The operation can be minimally invasive or more open, depending on the severity and location of the herniated disc. It is important that the patient talks to the doctor in detail before the operation to understand the risks and benefits of the surgery.
After surgery, it is important that the patient follows the doctor’s instructions and performs regular exercises and movements to strengthen and stabilize the spine. It may also be necessary for the patient to spend a certain amount of time in hospital after the operation to monitor healing and avoid possible complications.
Aftercare and rehabilitation
After treatment for a herniated disc, aftercare is a crucial step on the road to full recovery. The aim of rehabilitation is to restore mobility to the spine, strengthen the muscles in a targeted manner and prevent recurrence of symptoms. An individually tailored rehabilitation program usually includes physiotherapy exercises that help to improve the stability and flexibility of the spine. In addition, techniques for correct posture and back-friendly movement in everyday life are taught in order to minimize the strain on the intervertebral discs.
Even after successful treatment, it is important to regularly work on your own fitness and pay attention to the body’s warning signals. Special back training and targeted training sessions help to keep the spine healthy in the long term. Aftercare can also include advice on ergonomic adjustments at work or at home to avoid incorrect strain. This significantly reduces the risk of another herniated disc and improves quality of life in the long term.
Frequently asked questions
How are herniated discs diagnosed?
A herniated disc is usually diagnosed using a combination of medical history, physical examination and imaging procedures such as MRI or CT. Doctors follow the current guidelines of orthopaedics and trauma surgery to ensure a precise diagnosis and optimal treatment.
