Herniated
Disc

When the spinal cord or spinal nerves become compressed, they don’t work correctly, abnormal signals may get passed from the compressed nerves, or signals may not get passed.

Common symptoms of a herniated disc include:

• Electric Shock Pain
  Pressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms; when the compression is in the lumbar (low back) region, the shocks go down your legs; this may be severe and cause immobility due to the pain.
• Tingling & Numbness 
  Patients often have abnormal sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful electric shock sensations.
• Muscle Weakness 
  Because of the nerve irritation, signals from the brain may be interrupted, causing muscle weakness. Nerve irritation can also be tested by examining reflexes.
• Muscle Spasms 
  If the nerve irritation or compression is severe, this may lead to muscles going into spasms, causing pain and discomfort.
• Bowel or Bladder Problems 
  These significant symptoms may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc which is a medical emergency. You should see your doctor immediately if you have problems urinating, bowel movements, or numbness around your genitals.

An MRI is commonly used to aid in making the diagnosis of a herniated disc. Patients must understand that the MRI is only functional when combined with examination findings. It is usual for an MRI of the lumbar spine to have abnormalities, especially as people age. Patients in their 20s may begin to have signs of disc wear, which is expected on MRIs of patients in their 40s and 50s, and may not concern your physician from some MRI findings noted by the radiologist.

Making the diagnosis of a herniated disc and coming up with a treatment plan depends on the symptoms experienced by the patient, the physical examination findings, and the x-ray and MRI results. A reasonable treatment plan will be considered once this information is put together.

Most often, treatments of a herniated disc begin conservatively and become more aggressive if the symptoms persist. After diagnosing a herniated disc, treatment usually begins with:

• Rest & Activity Modification
  The first treatment is to rest and avoid activities that aggravate your symptoms. Many disc herniations will resolve if given time. In these cases, avoiding activities aggravating your symptoms is essential.
• Ice & Heat Applications 
  Ice and heat application can be beneficial in relieving the painful symptoms of disc herniation. By helping to relax the back muscles, ice and heat applications can ease muscle spasms and provide significant pain relief.
• Physical Therapy 
  Physical therapy and lumbar stabilisation exercises do not directly affect the herniated disc but can stabilise the lumbar spine muscles and decrease the load experienced by the disc and vertebrae. Stronger, well-balanced muscles help control the lumbar spine and minimise the risk of injury to the nerves and the disc.
• Orthoses and bracing solutions
  Suppose physical therapy or other treatments are contraindicated. In that case, immobilisation for periods of exercise or work, which reduce the load on the affected site, may minimise the risk of further damage or promote healing. These may be a simple elastic or lycra support or a more robust brace with additional compressive and adjustable support options.
• Anti-Inflammatory Medications 
  Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed and often help relieve the pain associated with a disc herniation. These medications can ease pressure on the compressed nerves by reducing inflammation, and NSAIDs should be used under your doctor’s supervision.
• Oral Steroid Medications 
  Oral steroid medications can be beneficial in acute (sudden) acute disc herniation episodes. These powerful anti-inflammatory medications reduce inflammation around the compressed nerves, relieving symptoms.
• Other Medications 
  Other medications often used include narcotic pain medications and muscle relaxers. Narcotic pain medications are helpful for severe, short-term pain management. Unfortunately, these medications can make you drowsy and can be addictive. It is essential to use these for only brief periods. Muscle relaxers are used to treat spasms of spinal muscles, often seen with disc herniations. Often the muscle spasm is worse than the pain from the disc pressing on the nerves.
• Epidural Steroid Injections 
  Injections of cortisone can be administered directly in the area of nerve compression. Like oral anti-inflammatory medications, the idea is to relieve the compression on the nerves. 

Surgical treatment of a herniated disc may be recommended soon after the injury if your problem has a significant neurological deficit. Symptoms of pain and sensory abnormalities usually do not require immediate intervention. Patients who have considerable weakness, any evidence of cauda equina syndrome, or a rapidly progressing problem may require more prompt surgical treatment.

Surgery is recommended if more conservative measures do not relieve your symptoms. Surgery is performed to remove the herniated disc and free up space around the compressed nerve. Depending on the size and location of the herniated disc, and associated problems (such as spinal stenosis, arthritis, etc.), the surgery can be done by several techniques. In very straightforward cases, endoscopic or microscopic excision of the herniated disc may be possible. However, this is not always recommended, and in some cases, a more significant surgery may need to be performed.