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Herniated disc: everything you need to know

A herniated disc is a painful condition that occurs when part of the intervertebral disc is able to filter into the hard outer layers of the disc, causing pressure on nearby nerves or the spinal cord.

It is the most frequent neurosurgical pathology and it stands out as one of the main causes of lumbar pain irradiated towards the gluteus and the leg. Its appearance is related to vertebral degeneration, physical overstress or trauma. It is more frequent after the age of 30 , especially in individuals with a sedentary lifestyle.

Causes of a herniated disc

Herniated disc: everything you need to know

A large number of cases of herniated discs derive from the gradual wear and tear that is experienced with aging (degeneration of the discs).

As time passes, the vertebral discs lose an important part of their water content , which decreases their flexibility and ability to cushion. This increases the chances of tearing or breaking, even with minimal effort or .

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Risk factor’s

  • Genetic predisposition
  • Excess body weight or pregnancy
  • Work of high physical demand
  • Repetitive actions that involve lifting or pushing objects
  • Repeatedly bending or twisting the lower back
  • Maintain the same body posture for a long time
  • Sedentary
  • Smoking

Symptoms of a herniated disc

Herniated disc: everything you need to know

Most of the time, disc herniations occur in the lower back (lower back); however, they can also occur on the cervical spine .

Pain in the arms or legs

When the herniated disc is located in the neck, the pain is intense and can spread to the shoulders and arms. In fact, coughing or sneezing can radiate to other parts of the spine.

If the problem is in the lower back, the pain can be felt more intensely in the buttocks, thighs and calves. In these cases, it is possible to feel it more severely when standing for a long time, to remain seated or when adopting some bodily postures.

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Numbness or tingling

People affected by this condition often experience a numb or tingling sensation in the parts of the body through which the involved nerves extend.

Weakness

The muscles that feed on the nerves affected by a hernia may have some level of weakness. This, in turn, affects the ability to perform some daily tasks.

Diagnosis

Herniated disc: everything you need to know

The first step in diagnosing a herniated disc is a careful physical examination and analysis of the medical history.

Depending on the area of ​​pain, the doctor will examine the neck, arms or lower back and the lower area of ​​the body. In conjunction with a physical analysis, some neurological tests can be done to verify:

  • Muscle reflexes
  • Muscular strength
  • Ability to walk
  • Numbness or sensitivity
  • Ability to perceive touches, punctures or light vibrations

Most of the times this evaluation is sufficient to make a diagnosis. However, if another condition is suspected, or if it is necessary to know which nerves are affected, the provider may also order other types of tests.

Medical exams

  • X-rays. They do not detect herniated discs, but they can determine other causes of back pain (infections, tumors, broken bones, among others).
  • Computed tomography and magnetic resonance imaging (MRI). They show if the hernia is exerting pressure on the medullary canal.
  • Myelography Determine the size and location of the hernia.
  • Electromyography (EMG). It shows the nerve root that is compromised by the hernia.

Treatment

Herniated disc: everything you need to know

Depending on the severity with which it occurs, the herniated disc is treated with a short period of rest accompanied by analgesics. If the symptoms persist, it is complemented with physiotherapeutic treatments. Sometimes the symptoms tend to be complicated or prolonged, being necessary the use of other medications and procedures.

Medicines

The administration of some medications can help control pain . Although some are over-the-counter, their consumption is always advised under medical supervision. These include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to control long-term pain
  • Narcotics (if the pain does not respond to NSAIDs)
  • Anticonvulsants to treat irradiated nerve pain
  • Muscle relaxants
  • Cortisone injections

Therapy

Patients who do not improve in a few weeks require physical therapy . Physiotherapists can design an exercise plan according to the affected person’s ability to minimize pain.

These will also help to correct body posture, especially when doing activities such as heavy lifting, walking, dressing, among others.

Surgery

A minimum number of people affected by disc herniations require surgery. The doctor considers this possibility when the treatments do not improve the symptoms , they last for a long time or present complications such as:

  • Constant numbness or weakness
  • Difficulty standing or walking
  • Loss of control of the bladder or bowel

Discectomy is the surgical procedure to remove part or all of an affected disc. Rarely, the surgeon suggests the implantation of an artificial disc.

Bibliography

  • Gardocki RJ, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013: chap 42.
  • Magee DJ. Lumbar spine. In: Magee DJ, ed. Orthopedic Physical Assessment. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014: chap 9.
  • Alvarez Cambras R. Herniated lumbar disc. In: Treaty of Orthopedic Surgery and Traumatology. Editorial People and Education. C. Havana. 1986; T II: 268-83.
  • Felipe MA; De Jongh DLF; Salomón CM, Fernández MR: Clinical, imaging and surgical results in 562 patients operated on for lumbar disc herniation. List of discussion Neurosurgery 99.Available in

Herniated disc: everything you need to know

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