The spine is composed of many vertebrae stacked on top of each other.
Between these bones are discs, which act as shock absorbers. The shock-absorbing
discs resemble jelly donuts, each having a jelly-like center. As we age,
the discs naturally become less flexible and more brittle. Normal disc
degeneration which naturally occurs with old age, can also cause pain.
Discs can herniate in any direction — forward, centrally
or, most commonly, backward and sideways in the direction of the spinal
Herniated discs account for a small percentage of back pain.
While herniated discs are often referred to as “slipped
discs,” this really isn’t accurate because discs don’t
ever slip out of position. They are actually attached by connective tissue
to vertebrae above and below. A disc herniation can be “contained”
or “uncontained.” With a bulge, for example, the jelly center
remains within the disc wall. "Uncontained" means the jelly
center has broken through the annulus wall but stays connected to the
nucleus pulposus. Or the herniation can be “sequestered,”
when it breaks free from the nucleus and travels away from the disc.
A bulging disc forms when the wall of the disc is deformed
but not necessarily herniated. The nucleus is still contained in the wall.
You NEVER need surgery to treat a bulging disc.
In the event of a fall or heavy strain, discs can rupture, causing the
nucleus to break through the wall of the disc and place pressure on the
nerves that branch out from the spinal cord. This results in a herniated
disc, accompanied by back or neck pain. For example, sitting down for
a while, then lifting a heavy object, can cause a disc to herniate.
Sometimes, people mistake excruciating pain for a herniated disc, when
the pain might actually be the signal of a muscle strain.
Because the nerve roots act as telegraph lines to other
parts of the body, a common complication of disc herniation is that it
can cause pain that is felt in other parts of the body. In fact, leg pain
below the knee is a common herniated disc symptom. This radiating pain
is called radicular pain or radiculopathy. Often, back pain without leg
pain can be a result of partial herniation of the disc or an internal
Outlined below are some of the diagnostic tools that your physician may
use to gain insight into your condition and determine the best treatment
plan for your condition.
Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside of
your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very safe
and usually pain-free.
CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somato sensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are performed
to view the disc composition to determine if its structure is normal
or abnormal. In addition to the disc appearance, your doctor will note
any pain associated with this injection. The benefit of a discogram
is that it enables the physician to confirm the disc level that is causing
your pain. This ensures that surgery will be more successful and reduces
the risk of operating on the wrong disc.
Injections: Pain-relieving injections can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.
Unlike muscles, which can heal somewhat quickly, a torn or degenerated
disc heals more slowly. The good news is that in many cases, the pain
and inflammation originating from damaged discs can be treated nonsurgically
by reducing the inflammation and by strengthening the musculature surrounding
the damaged disc to give it more support.
Special extension exercises can help relieve pain from a
herniated disc. Exercise can work like a vacuum to suck the center of
the disc back into place, helping release pressure on the nerve. Although
someone suffering an attack of back pain may find it hard to believe,
it has been proven that specific exercises can help relieve their pain.
Herniated discs can occur as a result of a heavy strain or fall, which
causes the nucleus to break through the wall of the disc and place pressure
on the nerves that branch out from the spinal cord. For example, lifting
a heavy object after sitting down for a long period of time can cause
a disc to herniate.
What is the best way to treat a herniated
Nonsurgical treatment methods are always the best option to try first.
This will most likely involve working with a physical therapist who will
develop a customized exercise program involving specific stretches and
extension movements for you.
Click here for narrated videos of spine surgeries, procedures and what causes various symptoms. Click here to see medical illustrations that help you understand back and neck problems. Click here to see an exercise library that has special stretches that can relieve pain symptoms.
Our spine Internet site acts as on-line spine encyclopedia. In addition, as a free community service, Spine Group Beverly Hills mails out Home Remedy Books on a limited basis to residents in Southern California. Click here to learn more.
We understand that traveling with a back problem can be difficult and unsettling. That’s why we enable you to set up a telephone consultation with Spine Group Beverly HIlls in advance, to determine if a trip would be worthwhile. Because this involves significant time for our practice to receive your information and diagnostics, and for Dr. Regan to review your case in advance of your call, there is a fee for this consultation. Click here to learn more.
The vast majority of back problems improve on their own or with nonsurgical treatment. There are a few warning signs, however, that may indicate serious spinal problems. If you experience any of these symptoms, seek medical attention immediately. Click here to learn more.