Neck, Back, and Spine Pain: Disc Herniation

Overview

A herniated disc refers to a problem with one of the rubbery cushions (discs) between the individual bones (vertebrae) that stack up to make your spine.

A spinal disc is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disc or a ruptured disc, a herniated disc occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior.

A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disc. Most people who have a herniated disc don’t need surgery to correct the problem.

Symptoms

Most herniated discs occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine). The most common signs and symptoms of a herniated disc are:

• Arm or leg pain. If your herniated disc is in your lower back, you’ll typically feel the most intense pain in your buttocks, thigh, and calf. It may also involve part of the foot. If your herniated disc is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
• Numbness or tingling. People who have a herniated disc often experience numbness or tingling in the body part served by the affected nerves.
• Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.

When to see a doctor

Seek medical attention if your neck or back pain travels down your arm or leg, or if it’s accompanied by numbness, tingling or weakness.

Causes

Disk herniation is most often the result of gradual, aging-related wear and tear called disc degeneration. As you age, your spinal discs lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Most people can’t pinpoint the exact cause of their herniated disc. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disc, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disc.

Risk factors

Factors that increase your risk of a herniated disc may include:

• Weight. Excess body weight causes extra stress on the disks in your lower back.
• Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disc.
• Genetics. Some people inherit a predisposition to developing a herniated disc.

Complications

Your spinal cord doesn’t extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse’s tail. Rarely, disc herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.

Seek emergency medical attention if you have:

• Worsening symptoms. Pain, numbness or weakness may increase to the point that you can’t perform your usual daily activities.
• Bladder or bowel dysfunction. People who have cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
• Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.

Prevention

To help prevent a herniated disc:

• Exercise. Strengthening the trunk muscles helps stabilize and support the spine.
• Maintain good posture. Good posture reduces the pressure on your spine and discs. Keep your back straight and aligned, particularly when sitting for long periods. Lift heavy objects properly, making your legs — not your back — do most of the work.
• Maintain a healthy weight. Excess weight puts more pressure on the spine and discs, making them more susceptible to herniation.