Herniated Disc (Disc Herniation)

What is a Herniated Disc?

A herniated disc (also called a slipped disc or ruptured disc) occurs when the soft, gel-like center (nucleus pulposus) of a spinal disc pushes through a tear in the tough outer layer (annulus fibrosus).

This can compress nearby nerves, causing pain, numbness, or weakness.

Imaging Appearance

On MRI, a herniated disc shows:

• Disc material extending beyond the normal disc space
• Compression or displacement of nerve roots
• Loss of normal disc height and hydration (dark signal on T2-weighted images)
• High signal intensity in the herniated portion on T2 sequences

MRI is the gold standard for diagnosing disc herniation.

Types of Disc Herniation

1. Disc Bulge

• Broad-based extension of disc material (＞ 50% of circumference)
• Milder than herniation
• Often age-related and asymptomatic

2. Protrusion

• Disc material extends beyond disc space but base is wider than the herniated portion
• Most common type

3. Extrusion

• Larger herniation where the base is narrower than the herniated material
• Higher risk of nerve compression

4. Sequestration

• Disc fragment completely separates from the main disc
• Free-floating fragment in spinal canal

Common Locations

Lumbar Spine (Lower Back) - Most Common

L4-L5 or L5-S1 levels:

• Sciatica - Pain radiating down leg
• Numbness in foot or toes
• Weakness in ankle or great toe
• Difficulty walking on heels or toes

Cervical Spine (Neck)

C5-C6 or C6-C7 levels:

• Neck pain radiating to shoulder or arm
• Numbness or tingling in fingers
• Weakness in arm or hand
• Difficulty with fine motor tasks

Thoracic Spine (Mid-Back) - Rare

• Chest or abdominal pain
• Leg weakness or coordination problems

Symptoms

Pain:

• Sharp, burning pain along nerve pathway
• Worse with coughing, sneezing, or bending

Neurological:

• Numbness or tingling
• Muscle weakness
• Reduced reflexes

Bladder/Bowel (Emergency):

• Loss of control = Cauda Equina Syndrome → requires immediate surgery

Causes and Risk Factors

Common Causes:

• Age-related degeneration (wear and tear)
• Sudden injury or trauma
• Repetitive strain (lifting, twisting)
• Obesity (increased disc pressure)

Risk Factors:

• Age 30-50 years
• Physically demanding work
• Smoking (reduces disc nutrition)
• Genetic predisposition

Diagnosis

Physical Examination:

• Straight leg raise test (for lumbar herniation)
• Neurological exam (strength, sensation, reflexes)
• Spurling test (for cervical herniation)

Imaging:

• MRI - Best test to visualize disc and nerve compression
• CT scan - Alternative if MRI unavailable
• X-ray - Does not show discs but rules out other problems

Treatment

Conservative Treatment (First-Line - 90% Improve)

1. Rest and Activity Modification:

• Avoid painful activities
• Gentle movements encouraged (not complete bed rest)

2. Medications:

• NSAIDs (ibuprofen, naproxen)
• Muscle relaxants
• Neuropathic pain medications (gabapentin, pregabalin)
• Short course of oral steroids

3. Physical Therapy:

• Stretching and strengthening exercises
• Core stabilization
• Posture training
• Traction (in some cases)

4. Epidural Steroid Injections:

• Anti-inflammatory medication injected near affected nerve
• Provides temporary relief (weeks to months)

Surgical Treatment (If Conservative Treatment Fails)

Indications:

• Severe pain lasting ＞ 6-12 weeks
• Progressive neurological deficit
• Cauda equina syndrome (emergency)

Procedures:

• Microdiscectomy - Remove herniated portion (most common)
• Laminectomy - Remove bone to relieve pressure
• Spinal fusion - Stabilize spine (if instability present)

Success Rate: 80-90% improve with surgery

Prognosis

Natural History:

• Most herniations improve within 6-12 weeks with conservative treatment
• Body gradually reabsorbs herniated material
• 90% of patients avoid surgery

Long-Term:

• 5-10% risk of recurrence
• Some patients have chronic low-level symptoms
• Lifestyle modifications reduce recurrence

Prevention

1. Maintain healthy weight
2. Exercise regularly (core strengthening)
3. Use proper lifting technique (bend knees, not back)
4. Maintain good posture
5. Quit smoking
6. Stay active (avoid prolonged sitting)

What Should You Do?

If you have a herniated disc on MRI:

1. Don't panic - Most resolve without surgery
2. Try conservative treatment first - Physical therapy, medications
3. Stay active - Gentle movement helps healing
4. Monitor symptoms - Track improvement or worsening
5. Follow up - Repeat imaging only if symptoms change significantly

Related Imaging Terms

• Disc bulge - Broader, less severe than herniation
• Spinal stenosis - Narrowing of spinal canal
• Nerve root compression - Pinched nerve

Common Questions

Can a herniated disc heal?

Yes! The body can reabsorb herniated material over time. Most improve within weeks to months.

Should I avoid all physical activity?

No. Gentle activity and specific exercises actually help recovery. Avoid only painful movements.

Will I need surgery?

Unlikely. Only 10% of herniated discs require surgery.

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Medical Disclaimer: This information is for educational purposes. Consult your doctor or spine specialist for diagnosis and treatment recommendations specific to your condition.