Definition of herniated disc
A hernia is the protrusion of an organ or part of an organ (usually the intestine) out of its usual position. A herniated disc is the projection of a portion of an intervertebral disc.
Between each of the 24 mobile vertebrae in the spine is an intervertebral disc formed of a fibrous and solid structure that contains a gelatinous nucleus. These discs give flexibility to the column and serve as shock absorbers in case of shock. Disc herniation occurs when a disc weakens, cracks or breaks, and part of the gelatinous core burst.
Lumbar disc herniation: the most common hernia
Although disc herniation can affect any area of the spine, the vast majority of herniated discs occur in the lower back, in the lumbar region. In this case, the hernia can cause low back pain. If the hernia compresses one of the roots of the sciatic nerve, it can be accompanied by pain along one leg: it is sciatica. A hernia can also go unnoticed; this is usually the case when it does not compress a nerve root.
Who is affected?
The herniated disc especially affects individuals aged 35 to 55 years. The men are more likely to suffer a herniated disc that women as they seek more physical strength through their occupation or sport.
It is difficult to assess the prevalence of herniated disc since some go unnoticed. Current data suggests that 1 in 50 people are affected at some point.
Causes of Herniated disc
- The degeneration of the intervertebral discs, that dries up with the age. The spine loses tonicity, elasticity and height.
- An abrupt action in a bad posture, such as lifting a heavy load in torsion position of the trunk.
- Excess weight and pregnancy, which increase tension on the spine.
- A hereditary predisposition: several members of a family are sometimes affected. Predisposed people tend to have herniated discs earlier, sometimes even before adulthood. Genetic abnormalities can cause weakness in the structures that make up the spine.
When to consult?
In the following cases, it is advisable to obtain a medical evaluation without delay.
- Your back pain has been present for more than a week and constrains your daily activities.
- Your back pain is caused by a fall or an accident.
- Your pains wake you up at night.
- Your pain is accompanied by unexplained fever or weight loss.
Usually, with good care and some precautions, hernias heal within 4 to 6 weeks. If this is not the case, consult a doctor again.
See an emergency doctor if your back pain is accompanied by urinary or fecal incontinence (or on the contrary, retention), impotence or weakness in the legs (to the point where you have difficulty stand or climb stairs).
Symptoms of Herniated disc
Thanks to medical imaging tests, we now know that two people who have an identical hernia problem will not necessarily have the same symptoms. For some people, the hernia goes unnoticed, while for others it is terribly painful. Here are the main symptoms.
- The pain tends to be exacerbated as soon as the back muscles are applied: when you lean forward, sneeze, cough or exert yourself. The pain also becomes more pronounced when sitting for a long time while standing or lying on your stomach.
- Disc herniation at the lower back: low back pain (low back pain) with or without pain in the back of a leg, along a sciatic nerve (sciatic neuralgia).
- Herniated disc located at the neck: stiffness and neck pain. The pain sometimes extends to the shoulders or arms, usually on one side only. Tingling, numbness or weakness can be felt in the arm and forearm.
People at risk for Herniated disc
- People who practice physically demanding jobs or sports.
- Pregnant women.
- The tall people.
- People whose close relative suffers from herniated discs.
Risk factors
- Neglecting your back: bad postures, lack of musculature, risky movements, etc.
- Obesity.
Prevention of herniated disc
| Basic preventive measures |
| Here are some basic tips for having a healthy back. This reduces the risk of herniated disc and the risk of recurrence.
A healthy lifestyle
Good posture
At work
Think about it
|
Medical treatment of herniated disc
The treatment of herniated discsprimarily involves resting, renouncing risky back behaviors and taking medication to relieve pain and reduce inflammation . In most cases, these measures are sufficient to reduce symptoms and heal disc herniation. In fact, about 60% of people with this condition respond well to these treatments in 1 week, and 90% in less than 6 weeks. The surgery is rarely necessary.
Rest the back
The bed rest may be useful for 1 or 2 days in maximum acute pain phase. However, it is best not to extend this rest beyond 1 or 2 days and to resume activities as soon as possible. Inaction and immobility can cause atrophy and weakening of the back muscles and compromise the normal mobility of the lumbar spine joints.
The positions that best fit the lumbar spine are as follows:
- lying on one side , knees bent, one pillow under the head and another between the knees (pregnant women can add a pillow under their belly);
- Lying on his back, without a pillow under his head, with one or more pillows under his knees and a rolled towel or a small cushion in the hollow of his lower back.
During the first few days, applications of ice to the spine near the hernia help to reduce pain (but not inflammation, lodged too deeply). Thereafter, it is suggested to apply heat or take hot baths.
Pharmaceuticals
To control pain temporarily and for a short time (usually 7 to 10 days, occasionally 2 to 3 weeks, but rarely more), painkillers (acetaminophen: Tylenol or acetylsalicylic acid: Aspirin) are usually taken. Anti-inflammatories (such as ibuprofen: Advil, Motrin, for example) or muscle relaxants (Robaxacet). If the pain is intense and persistent, the doctor may prescribe more powerful painkillers such as narcotics, or larger doses of anti-inflammatory drugs.
Note. It is important that pregnant women consult their doctor before taking any of these medications.
Injection drugs. To overcome persistent pain, epidural injections of corticosteroids or analgesics are sometimes prescribed. The injection of enzymes (chymopapain) into the intervertebral disk can also be practiced. The enzymes destroy the portion of the disc that protrudes and compresses the nerve, thus avoiding surgery. In contrast, enzymes tend to be less used because they can cause significant allergic reactions.
Physiotherapy
Once symptoms are relieved, the doctor may prescribe rehabilitation sessions to accelerate complete healing. These are mainly exercises that improve posture, strengthen the musculature of the back and abdomen and relax the body.
Surgery
The surgical treatments are used if the pain persist and are bothersome, if persistent weakness in an arm, leg, toe, etc., or if more serious symptoms.
Surgery eliminates the pressure exerted by the intervertebral disk on the nerve roots. Different techniques are used. The discectomy is to complete or partial removal of the intervertebral disc. This operation can also be performed in laparoscopy : it is microdiscectomy . This less invasive technique only requires a small skin incision. It is commonly used in the United States, but still little in Quebec. Both types of surgeries give similar results.
Surgery involves certain risks : getting an infection, nerve damage, fibrous scarring, or stressing other vertebrae.