Pain Patients: Learn about Herniated Discs

A Review of Intervertebral Discs for Pain Patients

Intervertebral discs are oblong structures within the spine that act as cushions between the vertebrae. The discs have a soft inner core and a firm, fibrous outer shell. This structure allows them to be sturdy enough to maintain space between the vertebrae, yet soft enough to compress with pressure during bending and leaning.

Some individuals, usually middle-aged adults, develop a tear in the outer shell of the disc.

This makes the inner core protrude out of its original position, a condition known as a herniated disc. If the herniation creates pressure on nerves in the spinal canal, it can lead to pain and numbness. In severe cases, the herniated disc can press on nerves that control the bowel and bladder, leading to incontinence.


It is not fully understood why disc herniation occurs, but it can be attributed, in part, to aging. Herniated discs are uncommon among young people. The disc’s outer shell appears to wear slowly, possibly due to years of upright posture that puts pressure on the spine. Genes might play a role in a person’s likelihood of developing a herniated disc. Studies are beginning to point out specific genes that may be linked to inheritance of degenerative disc disease. Working at a job that involves lifting heavy loads, repeated twisting, or repeated bending increases the risk of developing a herniated disc.

There are three regions of the spine where a herniated disc can occur. The first is the cervical region, which comprises the neck vertebrae. The second is the thoracic region which comprises the upper back. The third area is the lumbar region, consisting of the lower back down to the pelvis. Herniation is much more likely to occur in the lumbar region and is less common in the thoracic region.


Pain in the back around the affected area is usually the first symptom. If the inner core is protruding out and pressing on a neighboring nerve, the symptoms can differ depending on the location. If it occurs in the cervical region, there may be pain the neck, back, shoulder, chest and arm and possible numbness in the arm and fingers. If it occurs in the thoracic region, symptoms may be ambiguous and can last a long time. There may be pain in the back, chest, stomach or legs and possible numbness and weakness in the legs. Bowl or bladder incontinence is also sometimes reported.

 In the lumbar region, individuals may suffer years of recurrent and mild lower back discomfort before a specific event, like heavy lifting, aggravates the injury and necessitates medical attention. It may also occur without a triggering event. Most people note severe lower leg pain if the sciatic nerve becomes compressed, known as sciatica, that spreads from the buttocks down through the back of the leg and can cause tingling and weakness.

  If the nerve becomes increasingly compressed, it can lead to rectal pain, incontinence, and numbness around the buttocks and genital area.


A doctor will review medical history and ask specific questions about the pain in order to determine the cause of the pain. He or she will look for variances between the right and left sides of the back, limitations with movement, lack of flexibility, numb areas, abnormal curvatures, and muscle spasms to rule out other conditions such as cancer or bone infection. If symptoms of disc herniation are present, the doctor may observe the patient as he or she walks on the heels and on the toes, squats and stands in order to further assess the symptoms. A neurological exam may be necessary to determine if there are changes in reflexes or muscle weakness. If the diagnosis is unclear, the doctor will order a spinal x-ray, CT or MRI if the symptoms persist or if surgery is being considered. An electromyography is a test performed to evaluate muscle and nerve function and it can be used to identify irritation or compression of the nerves.


In many cases, a warm bath, heating pads, non-steroidal anti-inflammatories, muscle relaxants, and a few days of bed rest will ease the symptoms. An exercise regimen may be recommended as prolonged inactivity can promote weakness and intensify the symptoms. Epidural steroid injections can be helpful if the more conservative treatments fail. This involves injecting a steroid with an anesthetic into the area near the compressed nerves. If bowel or bladder control has been lost, if there is evidence that the nerve damage has progressed, or if severe pain persists for weeks, then more aggressive treatment such as surgery may be needed. A minimally invasive procedure in which the disc is removed using a hollow tube inserted through a small incision is becoming more common, but removing the herniated disc may require much more invasive surgery.

Seek professional medical care if severe back pain develops, pain and numbness develops in the arms and legs, or if incontinence develops. About 60% of people experience a decrease in symptoms about a week after conservative treatment begins and over 90% respond within 6 weeks. Surgery has a high rate of success when an MRI or CT scan shows surgery can correct the problem.

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