Your spine is made up of a column of bony “blocks” called vertebrae. Between each vertebra is a soft cushion called a disc.
The disc is made up of two parts: the annulus and the nucleus. The outer ring is called the annulus. It is tough and fibrous like gristle. The inner portion is a softer gelatinous material called the nucleus.
These discs help allow for mobility of the spine when we bend forward and back. They also act as cushions or shock absorbers between the vertebrae. Unfortunately, in some people the effects of repeated excessive pressure can cause the disc to rupture or herniate. This increased pressure can come from lifting something too heavy, using poor posture when lifting, or as a result of repetitive trauma.
As a result of aging and wear and tear, the disc will progressively decrease in height or “thin out.” This is a normal part of the aging process for the disc. The amount of water content making up a disc will decrease with age as well, so they become less effective as shock absorbers.
When the pressure on the disc causes the nucleus to push against the annulus to the extent that the annulus tears, you may get a ruptured disc (also referred to in the medical field as a herniated nucleus pulposis or herniated disc). The vast majority of ruptured discs will rupture posteriorly, or backwards, toward the nerves. Slipped disc, herniated disc, and ruptured disc are all used to describe the same condition.
Signs and Symptoms:
When the disc ruptures it may cause irritation of the nerves. I say “may” because there are many people who have a ruptured disc, but are not having any pain or other symptoms.
If the pressure on the nerve is sufficient enough to cause symptoms, one will often have pain going down the leg. This is the course the nerve runs, and is what many people refer to as sciatica. One may also experience associated numbness, tingling, or weakness involving the leg. Other symptoms, which are less common, include pain going down both legs and loss of bowel or bladder control. These could indicate a severe problem and you should contact your doctor or spine surgeon right away.
Dr. Irby has diagnosed and treated many herniated discs in Richmond, VA and beyond- and only a small amount of these cases actually required spinal surgery. In fact, there are many conservative ways to treat a herniated disc. Most people with a ruptured disc will get better without surgery. The first thing to do is rest and try over-the-counter non-steroidal anti-inflammatory drugs (NSAID) such as Advil™ or Aleve™ (make sure you have no contraindications to these medications, such as history of a heart attack, stomach ulcers, or allergy to the medicine, by reading the label).
If you have rested and tried an NSAID for several days without relief, seek medical attention. Depending on your symptoms and exam, the next step may be prescription medications (Prescription strength NSAIDS, steroids, pain medications, or muscle relaxers).
If medication is not effective then further testing may be needed. This test may be an MRI or a myelogram and CT scan depending on your specific case. Based on the results of these tests and your previous exams, an epidural steroid injection (ESI) may be recommended. This procedure is done under xrays during a separate visit. Cortisone (a steroid) will be injected around the nerve root being pinched.
Once you are feeling better, it is very important that you begin a back exercise program and a walking program to rehabilitate your back. By rehabilitating your back, you significantly reduce the chances of reoccurrence of sciatica. You should also use good back mechanics when lifting. This is discussed in greater detail under our “prevention of back pain” section. The final thing you can address is weight. Studies have shown that excess weight puts an increased load on your spine/back.
If you are unable to relieve your symptoms with conservative treatment, and test results show you have a herniated disk, then surgery may be necessary. Typically, a microdiscectomy is the spinal surgery that is performed for this particular condition.
If you believe you are suffering from a herniated disc in Richmond, VA or beyond, I urge you to contact us today to learn more about the various causes and treatments associated with herniated discs.