A herniated disc is a painful disease of the spine in which parts of a disc protrude into the spinal canal or the nerve hole.This is caused by many years of previous damage to the intervertebral discs due to incorrect or excessive strain on the spine. 90% of herniated discs (disc prolapse, discus prolapse) occur in the lower back (lumbar spine). Only rarely does a herniated disc occur in the area of the cervical spine. Typical symptoms are radiating pain in the neck or back. back area, a feeling of numbness can also occur. Treatment with analgesic and anti-inflammatory drugs, supported by physiotherapeutic exercises, quickly helps the majority of those affected. Surgery is required only in severe cases.
– The intervertebral discs act as shock absorbers between the individual vertebrae of the spine. They dampen the stress exerted on the spine during movement sequences. – The herniated disc is a sign of wear, in which parts of a disc enter the spinal canal. A frequent cause are permanent incorrect loads. – typical symptoms are pain, paralysis and sensory disturbances, which, depending on the exact position of the herniated disc, can affect the legs, arms or neck, among others. – Treatment usually involves a combination of drug therapy and physiotherapy. The reduction of any excess weight. The correction of possible malpositions are also important.
Frequency of herniated discs in Austria
Almost 40 % of the Austrian population states that they have suffered from back pain at least once. Most frequently, a herniated disc occurs in the area of the lumbar spine (90%), less frequently in the area of the neck (just under 10%) or in the area of the thoracic spine. About one-third of young adults have herniated discs on CT scan. But not every herniated disc causes pain. Most often affected are pregnant women, overweight people, people with sedentary jobs and people with untrained back muscles. 90 % of those affected are helped by drug therapy in combination with physiotherapy.
What are the roles of intervertebral discs?
Each vertebra of the spine consists of a compact vertebral body. These are flexibly connected to each other by intervertebral discs and ligaments, which make the spine mobile. The 23 intervertebral discs between the vertebrae act as shock absorbers: they consist of a gelatinous core with a high water-binding capacity, which is surrounded by a hard ring.
As soon as prere is exerted on the spine, z.B. when standing, walking or running, the intervertebral discs cushion the load like a water cushion. If the spinal column is z.B. when relieved during sleep, the intervertebral discs also regenerate. With increasing age, however, they lose their ability to bind water and become brittle.
The second function of the intervertebral disc is to restrict rotation (rotational motion). This prevents the small vertebral joints from being strained too much due to excessive movement deflections.
Herniated disc: Causes
A herniated disc is a sign of wear and tear that is based on a long-lasting incorrect or excessive load on the spine. Predisposition due to family history, predetermined spinal deformities, and poor posture are the most important causes. The wrong load on the spine in daily life also plays a major role. Here, however, it is not so much a question of the severity of the weight, but always of how the musculoskeletal system is overstrained: the most dangerous thing is the wrong lifting, carrying and moving every day.
Possible causes of a herniated disc are:
– a congenital weakness of the connective tie – spinal column changes due to vertebral fractures, inflammatory diseases of the vertebral joints, wear and tear of the vertebral joints or also due to tumors – neurological causes – pain occurs due to inflammation or entrapment of the spinal cord nerve – deformities (e.g.B.: Slipped vertebrae) – Family history – Posture (incl. Overweight, which "forces" an incorrect load due to the shape of the body
Lifting incorrectly, jumping from a great height, sudden twisting movements or abrupt, awkward movements can trigger a herniated disc. People with sedentary jobs, overweight people, pregnant women and people with untrained back muscles are particularly susceptible to this condition.
Why incorrect lifting is dangerous for the intervertebral discs
The two main functions of the intervertebral discs are cushioning and rotation restriction. This also explains why bending forward, twisting and lifting loads put so much strain on the intervertebral discs: natural aging leads to an increasing flattening of the intervertebral discs. This leads to an increased possibility of rotation of vertebrae, a reduced damping and also to a reduction in the size of the affected person. From this circumstance the degenerative disc disease arises, which leads to a disturbance of the movement (function) segment of the affected intervertebral disc.
Herniated disc is a disease of the spine in which parts of the gelatinous disc nucleus leak through the ring of the disc. This causes pain. In further consequence it can lead to a narrowing of the spinal canal with an "impairment" (compression) of the spinal cord occur. Nerves can also emerge from the spinal cord. This can lead to sensory disturbances, paralysis or even paraplegia.
Symptoms& Progression of a herniated disc
Prere on nerve roots can cause pain, paralysis or loss of sensation:
Herniated disc in the lumbar spine: Typical are lightning-like pains radiating into the leg ("lumbago") or also ischialgia). The sometimes unbearable pain can be aggravated by coughing, sneezing or pressing. It may be difficult for the affected person to lift a leg or move the toes, numbness in the legs and feet is also possible. In further consequence it can come to low back pain (Lumbago). The result is then the low back pain radiating into the leg.
Herniated disc in the area of the lumbar spinal cord (Kauda syndrome): in addition to the symptoms described above, there may be frequent disturbances in bladder and bowel emptying. In this case, immediate surgery is necessary.
Herniated disc in the area of the cervical spineNeck pain that can radiate into the arms and fingers, depending on the height of the intervertebral disc. This in turn with sensory disturbances and / or even paralysis. Affected persons have pain. Suffer also from discomfort when breathing. Pain radiating to the chest in some cases also suggests a heart attack.
If pain or other spinal impairment occurs, it is important to see a doctor as soon as possible. Because any delay in treatment can lead to a limited recovery of the sensitive nerve structure. In 90 % of those affected, the pain can be alleviated by taking medication. A movement therapy sustainably helped. Only about 10 % of herniated discs require surgery.
Diagnosis of herniated disc
The first port of call for back pain is usually the general practitioner. He will perform the Lasègue test if it is suspected: In this test, the patient lies flat on his back. The doctor slowly lifts the stretched leg higher and higher from the support. If pain occurs in the hip joint up to an angle of 40 degrees, this may be a sign of a herniated disc. Sensory disturbances and functional disorders (paralysis) are also signs of a herniated disc. To finally rule out malpositions and degenerative causes, an examination of the affected section by CT or MRI is performed.
herniated disc: therapy
For most herniated discs, drug therapy and physical rest are sufficient. Intensive physiotherapy should then be started. This leads to a lasting improvement in the symptoms of 90% of those affected. The doctor usually prescribes painkilling, anti-inflammatory drugs, and often also muscle-relaxing drugs are used in the acute phase. Supportive effect of heat on the muscles. It promotes blood flow to the affected area. In the case of a slipped disc, warming ointments, heat belts, hot water bottles or even fango packs can be used. In the case of pain in the neck area, the short-term use of an adapted cervical collar can be helpful in the acute phase in special cases.
If no improvement occurs under outpatient conditions, an inpatient admission with a variety of pain therapy can often still help (z.B. infusion therapy, physiotherapy, image converter or CT-targeted blocks, psychological care).
After the acute symptoms have subsided, intensive physiotherapy and exercise therapy should be carried out. The back and abdominal muscles are trained, the posture is improved and new faulty strains are prevented.
If there is no improvement after 6 weeks of treatment or if there is a worsening of initially mild symptoms of paralysis, surgery is necessary.
The gold standard for disc surgery is microdiscectomy, i.e. disc surgery via a minimally invasive approach using the surgical microscope. Most of the operated patients experience a significant improvement of the complaints afterwards. If there are additional underlying conditions such as z.B.