A herniated disc is one condition that affects millions of people around the world and, although it is common, it is often misunderstood. This condition can cause intense pain and limit the sufferer's quality of life.
In this article, we will explore herniated disc in detail, from its causes to the treatment options available.
Index
What is a herniated disc?
A herniated disc occurs when the soft material inside an intervertebral disc moves beyond its normal position.
Intervertebral discs work like shock absorbers between the vertebrae of the spine and are composed mainly of a gelatinous nucleus and a fibrous ring.
When this gelatinous nucleus herniates through the annulus fibrosus, it can press on the surrounding spinal nerves, causing a variety of symptoms.
Spine Anatomy
The spinal column is composed seven cervical, twelve thoracic, five lumbar, five sacral vertebrae (which are usually fused) and coccyx.
These vertebrae are articulated to each other through the facet joints and the intervertebral disc, together forming a tube that houses the spinal cord inside and allows the entry and exit of the peripheral nerves.
The intervertebral disc is a structure that is located between two adjacent vertebrae at both the cervical, dorsal and lumbar levels, acting as a load distributor to protect the posterior articular processes of the vertebra. In this way it cushions loads and stabilizes the movement between two vertebrae.
It is composed of the following elements:
- A central gelatinous part, the nucleus pulposus. The composition of the nucleus pulposus is 88%. water, and separated by fibrous tracts.
- A peripheral part, the fibrous ring, made up of cartilaginous tissue and collagen fibers in concentric sheets, preventing any externalization of the substance of the nucleus.
- A vertebral plate, composed of layers of hyaline cartilage forming the vertebral somatic limit.
This disc, subjected to repeated tensions over time, can suffer fiber degeneration (fibrous ring) that surround the nucleus pulposus, allowing a dehydration or drying of the structures, thus generating small lacerations called disc fissures, which produce back pain.
If the traumatic situation persists, a deformation of the fibers occurs and, having no vascularization, it does not have the ability to regenerate.
When it is in good condition (without pathology), the spinal column has a uniform diameter, despite the individual being in motion.
When a pathology appears in the mobile segments (arthrosis of the facet joints, protrusions or herniated discs), an unstable movement emerges between two vertebrae which is the main cause of back pain.
Phases or stages of disc degeneration
Disc injuries are classified into three groups: fissure, disc protrusion, disc herniation. Herniated discs in turn are divided into various types.
- fissure: It is a breakage of the rings closest to the nucleus, due to the strong pressures it bears. There is no neurological involvement.
- Protrusion: Disc protrusion or disc protrusion is a deformation of the fibrous rings of the disc, without there being any breakage of the same. It occurs when the tough, tough outer fibers (fibrous rings) of the intervertebral disc weaken, allowing the inside of the disc to swell.
In the protrusion or protrusion of an intervertebral disc the gelatinous substance of the nucleus pulposus protrudes (protrudes) from its normal limits in a pathological way and pushes the fibrous rings of the disc, producing a deformation in its structure.
In this deformation of the disc structure, neurological involvement occurs. The first symptoms of herniated discs begin. Back pain and involvement of the sciatic nerve path are the first symptoms.
- Herniated disc: Disc herniation is the degeneration and rupture of the fibers of the fibrous ring and, consequently, the exit or migration of part of the contents of the nucleus pulposus towards the outside of the disk, generally towards the medullary canal.
If the pressure to which the disc is subjected is greater than it can withstand, Finally, disc herniation occurs. A herniated disc occurs due to the rupture of an intervertebral disc, due to the pressure it is subjected to by the vertebrae.
Then the following happens: when the rupture of the intervertebral disc occurs, the substance inside comes out, being unable to maintain itself by expanding and hits against the exit of a nerve or against the posterior common vertebral ligament ( LVCP). In this case neurological involvement is important.
Herniated disc according to its orientation
- Median: develops simple low back pain.
- Posterolateral: the most common, involves the lateral recess. More lumbar pain than lower limb pain, pain on contralateral inclination.
- Foraminal: are those that occur in the junction hole. More pain in the lower limb than in the lumbar area.
- Extraforaminal: more lateral than the previous one and hurts with all movements that involve compression.
Herniated disc according to its characteristics
- Subobligatory hernias: simple or migrated there is nerve irritation and low back pain, so functional impotence is more important.
- Transligamentary hernias excluded: there is no compression of the nerve but there are radicular symptoms.
- Extruded hernia: the nuclear substance continues in connection with the disk, the LCVP (posterior vertebral common ligament) it is torn. Some patients recover without any change in the status of the hernia.
- Kidnapped: the nucleus ruptures the annulus and the posterior longitudinal ligament, LCVP ruptured. It tends to be very painful in both the lumbar and lower limbs and there may be an alteration of bladder control.
What causes a herniated disc?
The herniated disc is a mechanical injury to the spine. Sometimes, a blockage in the lower back may be the trigger, or this blockage may occur in another structure.
Although the most common case is caused by excessive efforts, other causes may exist, sometimes being a combination of several factors:
- Traumas which damage the intervertebral disc, falls or accidents which directly cause the displacement of the nucleus pulposus and, as a consequence of this displacement, the fibers of the fibrous ring break, thus causing disc herniation.
- Inadequate postures or movements, repetitive and with load that cause microtraumas on the disc. These inappropriate postures produce instability in the pelvic joint. Somatic dysfunctions or osteopathic lesions that compromise the intervertebral disc in the medium or long term.
- Visceral lesions which cause a deviation of the structure of the spinal column.
- Loss of the mathematical lines of the body, which cause an accommodation of the entire spinal column and, as a consequence, a lesion of L5-S1.
- Excess body weight, which produces more pressure on the disc, thus compressing the nerve.
- Weak lumbar and abdominal muscles.
- Repeated movements of flexion-extension of the trunk with loads.
- Repeated rotation movements, which cause a cut of the disc.
- For joint degeneration, dehydration or aging.
When does a herniated disc occur?
The fissure, protrusion or hernia of the disc occur when the pressure inside the disc is greater than the resistance of the fibrous envelope.
Because the fibrous envelope is one-third thicker in its anterior wall than in its posterior wall, most fissures, protrusions, and hernias occur in the latter.
The typical mechanism consists of the following sequential movement:
- Forward spinal flexion: by doing this, the disc takes more load at the front. Being of a gelatinous consistency, the nucleus pulposus is compressed against the posterior wall of the fibrous envelope.
- Significant weight load: doing so tends to compress one vertebra against the other, increasing the pressure inside the disc.
- Extension of the column with the loaded weight: by doing this, the increase in pressure of the disc which involves the load of the weight goes "squeezing” the nucleus pulposus towards the back with more force. If the pressure it exerts against the rear wall of the fibrous casing is sufficient, the casing tears (fdisc insure), it bombs (disc protrusion) or breaks (slipped disc). A similar effect can be achieved by repeating flexion-extension movements with a smaller load or even without load.
On every occasion, yes generate small impacts against the rear wall of the fibrous envelope. These mechanisms occur much more easily when the back muscles are not very powerful. If sufficiently developed, these muscles protect the disc through various mechanisms.
How to prevent a herniated disc?
- Physical exercise: which strengthens the muscles of the spinal column.
- Correct mobility and flexibility, especially in the lower part of the body.
- Postural hygiene: to avoid traumas and overloads.
- Life without tobacco: as it causes vasoconstriction, reducing the blood supply to the disc.
- Adequate night's rest: to rehydrate the disc.
- Avoid standing for long periods.
Pathology
These alterations at the disc level manifest themselves in the patient in two different ways:
- Spinal instability: The damaged disc is no longer able to maintain the basic needs of stability and causes pain. As a result, the patient tends to avoid movement, leading to muscular atrophy in the area, worsening the painful picture.
- Neurological involvement: Disc prolapse (both in disc herniation and protrusion) may come into contact with the spinal cord or nerve root exit, causing neurological involvement (brachialgia or lumbosciatica, depending on the nerve involved).
Diagnosis
To determine whether a herniated disc is the cause of a patient's problems, medical history and physical examination are key. Sometimes it can be useful to use too neurophysiological tests.
Although a herniated disc can be detected with a CT scan, magnetic resonance imaging it is the preferred procedure.
However, recent studies have shown that the MRI is not as reliable as once thought in diagnosing back problems: the same image was interpreted differently by different doctors, or even by the same doctor at different times.
What to do in case of disc protrusion or herniation?
First, obviously, is to put yourself in the hands of a trauma specialist who can direct and manage the treatment. Secondly, the priority should be to find the cause or possible causes of the injury and try to avoid or correct them.
A herniated disc or protrusion can sometimes cause lower back pain, but in many cases they can be asymptomatic. It is important to improve spinal mechanics, strengthening the back muscles, as well as improving mobility and flexibility, especially in the lower body. Therefore, we should do training, stretching and relaxation.
In hernias, the problem occurs in those cases where the contents that have left the nucleus press, for example, on a nerve root, leading to sciatica.
Il Treatment of herniated disc is usually conservative. In severe cases and when there is a surgical indication, microsurgery may be performed to eliminate existing pressure, for example, on the nerve root.