The vertebral column is segmented, made up of vertebrae with each vertebra separated from the other by an intervertebral disc. Their relationship could best be described by imagining a tower built out of blocks of bone in which an eraser is placed between each block. The intervertebral disc, then, is an elastic bonding element acting as a shock absorber and reducing the vibrations emitted when walking. If we should make a hole in the blocks, the canal thus formed in the center of the blocks set one upon the other, becomes the spinal canal wherein runs the spinal cord. A healthy intervertebral disc is similar to a flat cake, its consistency is that of an eraser, is made up of concentric rings and has a gelatinous center containing liquid. A herniated disc is formed when the concentric rings are broken through and the gelatinous liquid pushes out toward the spinal canal where it forms an hour-glass shaped narrowing.
The Formation of a Herniated Disc
Before discussing the formation of a herniated disc, we must first understand the process of disc degeneration.
Disc degeneration is the result of the natural process of aging which begins, in all of us, at age 20. The essence of the process is that the disc begins to dry, loses water and, thereby, also loses its elasticity. In the presence of external forces or pressure, the degenerating disc becomes vulnerable, the rings break through at sudden increase in weight bearing, and the material within the disc wanders to the back forming the forward protrusion mentioned earlier.
The sudden increase in weight bearing may be due to a bad movement, lifting, or even excessively intense exercise begun after an extended period of not exercising or without first warming up. It becomes evident, concluding from the above, that those carrying excessive weight are in increased danger as are those exercising seldom who, when they do, do so with extra intensity (without warming up or the help of a professional trainer).
Classic symptoms of a herniated disc
Intense, sharp pain irradiating from the waist toward the hip joint, often down to the knee, or even to the ankle.
The above complaints may be accompanied by numbness in the lower extremities.
The symptoms often develop slowly, insidiously.
In rare cases, the pain may be accompanied by weakness in the legs and, in still rarer cases, with urination and bowel movement problems.
A physician should definitely be consulted if any of the above symptoms are present or if the pain did not decrease significantly with general pain killers within two days or disappear completely within a couple of weeks!
The Treatment for a Herniated Disc
Let us begin by saying, in reassurance, that less than 10 percent of the herniated disc cases require surgical treatment. It is very important that, for diagnosis, the newest, most modern diagnostic methods (CT or MRI) be used. A short physical examination or x-ray will not discover a herniated disc in anyone. The examinations should be overseen by a rheumatologist, orthopedic surgeon or neurosurgeon!
Following diagnosis, the first step, with few exceptions, is conservative (non-surgical) treatment.
In milder cases, this entails treatment with medications. The medications used are the so-called “non-steroid type anti-inflammatory medications".
If, within 7-10 days, the pain has significantly decreased, the next step would be spine exercises under the direction of a physiotherapeutist. In cases of intense pain, exercise is not recommended. The pain must have decreased before any curative exercising may begin!
In cases of more serious, or even handicapping pain, in-hospital treatment may be necessary. The first step here also would be conservative treatment in the form of intravenous infusion. (The infusion in these cases would almost always contain steroids.) The treatment may also include an injection given near the spine, a block injection, and an epidural injection given into the spinal canal. The treatment usually lasts 5-7 days and is usually also followed by curative gymnastics.
Should neurological symptoms be manifested, or the intense pain not decrease within 4-6 weeks under the treatments above, surgery might be recommended. This would entail, in all cases, the removal of the disc protrusion (hernia) pressing upon the spinal cord and nerves.
There are several surgical techniques for treating this condition (laser disc decompression, microscopic microdiscectomy, etc.). The location and size of the hernia, the technical conditions and the surgeon's training determines the surgical method of choice. The surgery is done under anesthesia with the Patient usually discharged in 3-5 days. The spine must be strictly indulged 6 weeks following surgery which does not mean lying about all day. The Patient is to continue doing, on a daily basis, the exercises taught in hospital and go for walks. Most importantly, the Patient must not overly strain the spine. The key word here is “gradual".
The sutures are removed 10-14 days following surgery. One week following suture removal, swimming is allowed. In the case of intellectual work, may resume work in 6-8 weeks, physical work, in 10-12 weeks.
It is important to remember that only the protruding (herniated) portion of the disc is removed during this surgery. The degenerated portion is left intact, making it very important that exercise become part of the Patient's daily life. The Patient may live a full life, even become pregnant, after surgery.