Herniated Spinal Discs, Explained

A bulging or slipped disc is a frequent cause of low back pain and neck pain.

For people who suffer from chronic back pain, determining the cause is the primary and most crucial step in eliminating it. In people who suffer from lower back pain (and sometimes neck pain), a herniated disc can be a common and often painful cause. Understanding what herniated discs are, the types of symptoms they present, and how they’re diagnosed and treated, can help people know when to visit the doctor.

Between each vertebra in the spine is a soft gel-like cushion, or disc, that protects the vertebrae from rubbing against each other. Many refer to the disc as a sort of shock absorber that supports the spine. A herniated disc occurs when that supportive cushion is damaged and begins to protrude. The protrusion often places pressure on the surrounding spinal nerves, resulting in irritation, inflammation, and pain sensation that other symptoms may accompany. In most cases, a herniated disc is simply the result of spinal degeneration. As we age, the spine’s anatomical structures can break down, and the disc can dehydrate and weaken. In other cases, a disc herniation can be caused by a traumatic spine injury, such as a fall or a car accident. Less often, the cause can be attributed to a congenital (present at birth) or connective tissue disorder. From a statistical perspective, herniated discs tend to occur more frequently in people between the ages of 30-50 and are more common in men.

Herniated disc pain is unlike back pain from a mechanical (or muscular) problem in the spine. Instead, pain from a herniated disc tends to cause a burning or stinging sensation that may radiate down one leg. In more severe disc herniation cases, the pain may also be accompanied by weakness or sensation changes in the affected limb. The most frequently affected area where a spinal disc herniation occurs is the lumbar spine, commonly known as the lower back or the lumbar spine. The runner-up is a herniated disc in the neck, which is medically referred to as the cervical spine. The reason a herniated disc affects the lumbar or cervical spine more often than the mid-back or thoracic is related to the load-bearing properties of the spine, with biomechanical forces putting more pressure on the low back and the neck than on the middle of the spine.

A history and physical examination are where spine specialists begin when getting to the bottom of a patient’s back pain. When discussing a herniated disc with a patient, they may remember an “inciting event” or an injury that occurred while lifting or twisting. Magnetic Resonance Imaging, or MRI, is typically the imaging examination chosen to diagnose a herniated disc accurately. For precise evaluation of a herniated disc, imaging studies are not indicated until the patient has experienced at least three weeks or more of persistent symptoms. Sometimes, a herniated disc in the spine causes no pain at all, and the diagnosis is revealed on MRI incidentally or when a different issue was under investigation.

The excellent news about herniated discs is that many will heal independently within a few weeks after symptoms have presented and don’t require specific treatment. Others may require some course of non-steroidal anti-inflammatory medication or physical therapy. At this time, unfortunately, there are few safe or effective conservative (non-surgical) treatments for a severely herniated disc – especially one that involves nerve damage or extreme inflammation. In these cases, surgical treatment to repair the damaged disc is in order. Depending on the disc herniation location, either a lumbar microdiscectomy or cervical discectomy and fusion may be required. During a microdiscectomy, the herniated part of the disc is removed to relieve pressure on the spine. On the other hand, a discectomy and fusion involve removing the entire damaged disc and replacing it with bone, and sometimes metal, to help support the spine.

Even when surgery is required to repair a herniated disc, minimally invasive approaches can make this a more successful procedure than ever before. Minimally invasive spine surgery is a concept used to afford better patient outcomes with shorter hospital stays, less blood loss, and fewer days of recovery. Minimally invasive surgical techniques are “muscle-sparing,” utilizing methods to access the spine that result in less trauma to the surrounding tissues. These surgeries are performed through smaller incisions without damaging the muscle tissue and sparing the ligaments and surrounding tissues. This helps his patients get back to living pain-free lives, sooner.

Most people don’t prepare for back pain. But many of us will experience it at some point (or multiple points) in our lives. When it comes to the herniated discs that are common causes of low back pain and neck pain, knowing what to be on the lookout for is crucial. If you or someone you know is suffering from chronic back pain and the cause is undiagnosed, advise them to see a spine specialist as soon as possible. No one should have to live with chronic back pain, and too many Americans do.  With education and a proactive approach to spine health, we can fix that.




Neel Anand MD