A herniated disc in the spine is a condition in which the nucleus pulposus of the intervertebral disc escapes through the torn or ruptured annulus fibrosus and invades the spinal canal, displacing or pinching nerve roots. It is one of the most common causes of radicular and back pain, and can become incapacitating. In this article, Dr. Santander explains how herniated discs are diagnosed.
The spinal column is structured with a series of vertebral segments that behave, for biomechanical reasons, as functional units. Each segment is composed of two vertebrae, with an intervertebral disc lying between them.
These discs are shaped like small, round pillows surrounded by a tough, fibrous ring (annulus fibrosus) that contains the soft inner material (nucleus pulposus). Their function is to act as shock absorbers for the bones of the spine when they bear weight.
A disc herniation occurs when a fragment of the nucleus pulposus slips out of the torn or broken fibrous ring into the spinal canal. Herniated discs usually occur at an early stage of spinal degeneration. Because the spinal canal houses the spinal nerves and has limited space, when a large fragment of a herniated disc pushes into it, it can put pressure on and displace the spinal nerves, often producing pain, which can become severe.
Dr. Xavier Augusto Santander, one of the neurosurgeons specializing in minimally invasive spine surgery at Instituto Clavel, explains how a herniated disc is diagnosed.
Types of disc herniations
A disc herniation is one of the most common conditions resulting from degenerative disease of the spine. The different types of herniated discs are determined according to the region of the spine where they are located and the symptoms they cause:
- Lumbar disc herniation. These hernias occur in the lumbar spine, most commonly at the L4-L5 and L5-S1 level. The most common symptom of this type of hernia is lower back pain, which can also radiate to the leg, buttock or thigh. Sometimes, if the disc hernia is large, or has been affecting a nerve root for a long time, the patient may even suffer loss of the ability to flex or extend the foot.
In the most severe cases, in addition to the loss of strength and feeling in both legs, the patient may suffer a loss of sphincter control. This is known as "cauda equina syndrome" and is a surgical emergency.
The main cause of lumbar hernias is the natural wear on the disc, in most cases due to poor posture habits, and they are most likely to occur in patients from age 30 to 50. In most cases, they do not require surgery, unless conservative treatments do not work or if it is necessary to relieve the pressure on the compressed nerve root.
- Cervical disc herniation. The main causes of this type of hernia are an accident or injury to the neck, use of poor posture, or degeneration due to age. It can affect any disc of the cervical spine, but most often affects the C4-C5 and C5-C6 level.
The symptoms of this type of hernia include pain in the arm, a sensation of numbness and tingling, or weakness in the arm that makes it difficult to raise the shoulder, or to grasp things with the hand, depending on which nerve root is affected. The hernia may be treated with conservative options, such as physical therapy, postural re-education, and supervised therapeutic exercise. However, if it puts pressure on the spinal cord, it can affect the legs and bowel control as well. When that happens, it is called cervical myelopathy and requires urgent surgery.
- Thoracic disc herniation. This is the least frequent type of disc herniation. Its most notable symptoms are discomfort in the area of the scapulae and the upper back. The patient may also suffer loss of strength and feeling in their limbs and abdomen, and it can lead to bowel problems.
These hernias are often calcified and large, remodeling even the surrounding bone. This makes it difficult to treat with surgery, so treatment usually consists of conservative measures including medications and rehabilitation.
The link below provides further information about the different types of disc hernia and how they can affect the sufferer’s day-to-day life:
Diagnosis of a herniated disc
"How do I know if I have a herniated disc?" First, you need to know that herniated discs can occur because of overexertion, poor posture, or lifting or carrying excessive weight. However, it’s also true that the intervertebral disc material naturally degenerates as the years go by, and the ligaments that keep the vertebral segment stable begin to weaken as we age. As this degeneration progresses, even relatively minor stress or a twisting motion can cause a ring to break and the disc to escape.
Certain people may be more vulnerable to disc problems and, as a result, they can have herniated discs in various locations along the spine. At Instituto Clavel, we recommend that you see a doctor if you suffer from continuous back pain and some of the symptoms we have described above.
To diagnose a herniated disc, the procedure almost always begins with a careful physical examination and review of the patient's medical history. Depending on where your symptoms are located, your doctor will examine your neck, shoulder, arms, and hands, or lower back, hips, legs, and feet. Some signs or symptoms will be checked, such as:
- Numbness, numbness, loss of sensation, or tingling
- Muscle reflexes, which can be slower, absent, or sometimes exaggerated, as is the case with myelopathy.
- Muscle weakness, as there may be loss of strength. This is usually explored in relation to flexion/extension movements and the limits of ability to resist gravity and force.
Diagnostic tests that may be done to determine if there is a herniated disc, and what type, include:
- Magnetic resonance Imaging (MRI). This is the most widely used and preferred test for detecting a herniated disc. It offers a more detailed view of the surrounding vertebrae, discs, and soft tissues, including the spinal cord and any affected nerves. With an MRI you can see exactly which root is affected and the exact location of the hernia: central, lateral recess, foraminal or extraforaminal. This helps plan and perform surgical treatment.
- Computed tomography (CT) scan. This imaging technology can also be helpful in diagnosing a disc hernia. A CT scan consists of a series of x-rays that provides more detail about the bones of the spine than a standard X-ray, however it does not provide as good quality for the soft tissues in the spine. This type of imaging test is of vital importance if, in addition to removing the hernia, we have to instrument the spine.
At Instituto Clavel, we also have the EOSedge scanner. Advances in technology such as this state-of-the-art vertical scanner, which provides high-resolution radiographic whole-body images, have greatly improved the diagnosis of spinal conditions. Detailed visualization of the anatomy of the patient's spine, including its sagittal balance, is a great help for achieving better surgical results and avoiding possible complications.
Dr. Clavel, neurosurgeon and Director of Instituto Clavel, talks more about the importance of this vertical scanner in determining the nature of a problem in the spinal column in the following article:
Diagnosis of spinal pathologies
Fortunately, most herniated discs do not require surgery. However, if doctors indicate that surgery is necessary, it is important to get it done. The consequences of not having surgery on a herniated disc can range from permanent pain to partial paralysis or irreversible nerve damage.
That is why it is important to ask your surgeon what kind of surgical options there are, their respective advantages and disadvantages, and what is involved in the procedure they recommend for you. At Instituto Clavel, we have a firm commitment to making sure our patients have this information.
If your doctor diagnoses you with a herniated disc, the first step to address it will be conservative treatments (for example, medications and muscle relaxants to relieve pain). With the help of the IC Rehabilitation team, you will be able to learn proper appropriate body mechanics and personalized exercises that will help you recover from your symptoms. You can learn more about this in the following article:
Exercises for a herniated disc
We hope this article has helped you understand how a herniated disc is diagnosed. Please, don’t hesitate to contact us if you have any questions or would like to request an appointment.
Categories: Spine treatments, Spine pathologies, Back pain