Herniated and Degenerative Discs

A disc herniation is a condition that can occur anywhere along the spine, although it most commonly occurs in the neck and lower back. A herniated disc is also known as a slipped or ruptured disc. A herniated disc occurs when the inner portion (nucleus pulposus) protrudes through the outer ring (annulus fibrosis) which leads to compression of the spinal nerves causing neurological symptoms. These symptoms may include pain, numbness, tingling and weakness in the distribution of one or more of the nerve roots. As we age, the risk of a herniated disc increases. This condition is incredibly common, with an estimated 3 million cases reported in the United States each year. Herniated discs most commonly occur in people over the age of 40, and they affect slightly more men than women.

Disc degeneration may occur from mechanical, traumatic, and genetic factors that can influence the integrity of the intervertebral disc. The degenerative disc cascade involves structural damage and includes changes in number and composition of cells in the disc. Often proteoglycan loss occurs and influences the ability of the disc to withstand compressive forces. Degenerative changes of the disc are often related to changes in adjacent structures including facet joints. Degenerative disc disease also leads to functional changes. An inflammatory cascade may also occur with degenerative disc disease which can result in irritation of surrounding structures including associated spinal nerve roots. This inflammatory cascade may result in increasing muscle tension, muscle spasms, and local tenderness in the back or neck. If a nerve root becomes inflamed it can lead to upper extremity (cervical radicular) pain, or lower extremity (lumbar radicular) pain.

Painful disc degeneration is common in the cervical and lumbar spine as these areas undergo the most motion and stress.

Typically, physicians will employ a physical exam including neurological exam, along with a patient’s history, to make a positive diagnosis. Imaging (e.g. MRI) is used to confirm the diagnosis. Fortunately, most cases of pain associated with herniated discs resolve with conservative strategies. Typically, this process takes weeks to months for resolution of symptoms to occur. During this healing time, non-opioid pain medications may be employed to assist in treatment. Medications may include NSAIDs, muscle relaxants, and oral steroids. Physical therapy and chiropractic care are also helpful. Lifestyle changes may also be implemented which include weight loss and exercise (e.g. core strengthening), which will help protect and stabilize the spine to reduce the pressure on the discs. Tobacco cessation is also important in individuals that utilize tobacco. Compelling evidence associates smoking to the degeneration of the disc.

In some cases, if your symptoms do not resolve, your physician may recommend surgical intervention. Surgeons can remove part of or the entire herniated disc to help relieve symptoms