A herniated disc is a degenerative and wear-related disease on the intervertebral discs and lumbar spine or cervical spine. It mainly involves deformation and bruising on the individual vertebral bodies. This process can cause severe pain and radiate to the extremities (arms, legs, feet).
What is a herniated disc?
Schematic anatomical representation of the vertebrae and the intervertebral disc, as well as the pinched nerve. Especially older people today suffer from problems of the intervertebral discs. These mostly affected herniated discs are based on complications in the lumbar spine or cervical spine. In most cases, a herniated disc occurs as a result of wear and tear on the intervertebral discs. The elastic buffers that sit between the vertebrae of the spine are worn away over time. Since the spine is now directly exposed to shocks and dampers, the intervertebral discs can no longer absorb the shocks. Wear and tear on the lumbar spine results in severe and stabbing pain in the back or legs, while the shoulders, arms and hands are particularly affected in cervical spine herniations. In addition to the pain, patients often feel sensory disturbances such as numbness or tingling. More rarely, there are also problems in the genital and anal areas that require urgent medical attention. Especially people in older age (from the age of 45) suffer from herniated discs, because in them, mostly due to age, increased wear and tear has occurred in the lumbar spine and cervical spine.
Causes
The underlying causes of a herniated disc are the wearing changes in the disc, which can then become apparent, especially in older people. Younger people can also get this disease, but the causes here are more likely to be due to general injuries or overload. For example, if disc material penetrates into existing cracks during prolonged stress, the adjacent longitudinal ligament may rupture. This destroys the gelatinous cosistency of the disc and severely degrades its function as a buffer between the bones. The particles can now constrict the spinal cord or spinal nerves, causing severe pain or sensory disturbances. Common external causes, in addition to the signs of wear and tear in old age, are obesity and a continuous incorrect load on the spine (e.g. constant incorrect sitting in the office). Also a lack of good back muscles, can promote herniated discs.
Symptoms, complaints and signs
Not every herniated disc causes symptoms. Thus, their occurrence and extent depends on whether nerve structures are affected and to what extent this occurs. Therefore, many people have a herniated disc without suffering from symptoms. Symptoms appear when this results in pressure on a nerve root. The result is usually severe back pain. In addition, the muscles in the region of the body affected by the prolapse harden. If the herniated disc occurs in the lumbar spine (LS), the pain can sometimes radiate to other areas of the body. This usually includes the leg or the buttocks. Some patients also experience tingling in the leg. In addition, paralysis of the leg muscles is possible. If the affected person suffers from a herniated disc in the cervical spine, this often results in neck pain that radiates to the back of the head, arm or hand. Another common symptom is sensory disturbances such as numbness, a feeling of coldness or tingling in the affected limbs. In the case of a herniated disc, there is also a risk of deficits and muscle weakness in the legs or feet. There is a risk that the patient will stumble for no reason or suddenly buckle when climbing stairs. In most cases, the symptoms appear in the lumbar spine. In contrast, they occur much less frequently in the cervical and thoracic regions.
Course
In the course of the disease in a herniated disc, symptoms may worsen and discomfort may worsen. Likewise, chronic symptoms can also develop. In many cases, however, a herniated disc also remains undetected and is accordingly not treated by the doctor. The course of a herniated disc is usually integrated into the therapy or treatment.Thus, conservative therapy is particularly promising. Surgical intervention is only necessary in exceptional cases when severe complications occur. Surgery should be resorted to especially in cases of lasting damage, such as inflammation of vessels and nerve cells.
Complications
Various complications can occur in connection with a herniated disc. Complications usually occur when the patient waits too long before beginning therapy. As a herniated disc progresses, pain may increase. In addition, numbness, weakness or insensitivity may occur in the affected body parts. Other parts of the body may also be affected. For example, a herniated disc in the neck may cause decreased strength and sensory disturbances in the arms. The nerve damage can also lead to paralysis of the bowel and bladder. Consequently, the patient has problems urinating and defecating. Pain associated with a herniated disc can trigger muscle tension. Consequently, the joints are misloaded, and further pain occurs. The clinical picture becomes progressively more severe. The pain can also become chronic after the herniated disc has been repaired. If a herniated disc is not treated, it becomes permanently larger as the disc continues to be stressed, forcing more disc contents into the spinal canal. Pain increases. If the herniated disc is very large, the blood supply to the nerve root is often cut off. Root death then occurs. Pain is not transmitted, and the patient has less discomfort. However, there is also no flow of information to the corresponding muscles. The muscles are thus numb.
When should one go to the doctor?
If a herniated disc is suspected, a doctor should be consulted immediately. If back pain persists for more than three to five days or recurs, a doctor must clarify the cause. This is especially true if the pain radiates to the arms and legs or is accompanied by symptoms of paralysis in the limbs and lower body. Back pain after an accident or lumbago also indicates a herniated disc and should be clarified quickly. People who do little exercise or sit a lot at work, lift heavy loads or generally perform physically stressful activities should have any back conditions examined. Through a quick diagnosis, harmless back pain, but also herniated discs can usually be treated well. If the back pain is accompanied by a poor general condition or other symptoms such as fever and weight loss, this indicates a serious underlying condition. A visit to the family doctor should then no longer be postponed. Other contacts for a herniated disc are physiotherapists, orthopedists, chiropractors or rheumatologists.
Treatment and therapy
Therapy of a herniated disc can only be performed by a doctor. Thus, the diagnosis is made with the help of computed tomography (CT) or magnetic resonance imaging (MRI). As a rule, the therapy is carried out without surgery. Much more, a change of lifestyle, pain therapy and rest of the affected areas are addressed. Above all, the spine should be subjected to less stress and relieved by aids. A cervical collar and a stepped bed are particularly suitable for this purpose. In addition to general pain relief, gymnastics and physiotherapy are also recommended to support the damaged areas through targeted muscle development. The back muscles in particular should be trained. However, if nerve damage has already occurred, surgical removal of disc material is necessary. Nevertheless, this form of treatment is used in only 10% of all herniated discs. In this case, part of the broken disc is then removed.
Prevention
There is no prevention that works one hundred percent. Nevertheless, a lifestyle that minimizes the risk of herniated discs can be preferred. These include:
- General muscle training to relieve the spine.
- No excess weight
- Avoiding overloading (e.g., carrying weights that are too heavy).
- Little sitting, a lot of movement (or ergonimic seating).
View and prognosis
The prognosis and outlook for a herniated disc can vary widely. It also behaves in such a way that circa half of all herniated discs are not noticed, because they do not cause any symptoms. Whether they do so later on (untreated) depends on chance. In younger people, a herniated disc often leads to the familiar pain, which is acute and severe. These phases of pain alternate with pain-free phases. In older people, on the other hand, the chronicity of the pain is more common. If the herniated disc is not treated, the symptoms can increase. In addition to back pain or other initial symptoms, there are also paraesthesia, paralysis, a tingling sensation and other sensations that can be traced back to compressed nerves. The pain itself also radiates after a period of time. Where they are felt most strongly depends on the affected vertebra. The prognosis in case of treatment is good. In up to 90 percent of cases, conservative treatment is sufficient to treat the herniated disc. Also 80 percent of all corresponding operations are successful, although these can lead to complications and consequential damage with a small chance. A herniated disc that has been overcome by no means means means that it cannot occur again in the same or another location.
Aftercare
A herniated disc can be treated surgically or conservatively. In both cases, consistent follow-up care is important to prevent recurrence of symptoms. In the case of surgery, it is important to follow the instructions of the nursing staff or medical team exactly afterwards to ensure the best possible recovery. This includes rest and physiotherapy, the learned exercises of which are also continued at home. Muscular imbalance is an important factor in the development of herniated discs. For this reason, it is important to strengthen weak muscles and stretch shortened muscles as part of aftercare. This can be done in a rehabilitation sports group as well as at home after initial instruction in the gym. Weight problems have a negative effect on the intervertebral disc situation because they put a lot of strain on it. therefore, good aftercare also includes weight reduction, if this should be necessary. Sufficient drinking also has a positive effect on the moisturization of existing intervertebral disc tissue, which can then fulfill its buffering effect particularly well. The sleeping position is also important: a mattress that is adapted to the weight, sleeping position and other needs of the person affected protects the back during sleep. Back school is also part of aftercare. It teaches patients how to move in a way that is appropriate for their back in everyday life. This supports regeneration and prevents new disc problems.
What you can do yourself
Pain relief from a slipped disc is provided by heat and step positioning. A hot water bottle or ointment that promotes blood flow can be helpful. Step positioning means that the legs are placed at right angles to the body. Sufferers do this by lying on the floor and placing a chair close to the lower part of the back. Calm breathing in and out is then important as it promotes relaxation. Pain from herniated discs in the chest area can also be reduced by heat. Even if every movement becomes torture at first, the resting position should only last one to two days. After that, the spine must be moved, albeit gently, but regularly. Only then will normal blood circulation be established and the synovial fluid be adequately nourished. Light exercises that strengthen the muscles of the spine are effective not only prophylactically. They also provide relief from pain. They can be performed while lying, sitting or standing. It is important not to put too much strain on the body and move it to the pain threshold. For sedentary activities, a special pillow can provide relief. This also applies to longer car journeys. Seat balls are also recommended. The short duration of getting used to is worthwhile here at any time. The entire back is relieved as well as permanently and gently moved.
