Herniated Disc Disease
Herniated disc disease can be very painful. The intervertebral discs are the shock-absorbing cushions between each pair of vertebrae in your spine. Each disc has a strong outer ring of fibers, called the annulus, and a soft, gelatinous center, called the nucleus pulposus. The disc’s nucleus serves as the main shock absorber for the adjacent vertebrae.
If you get a tear in the outer (annular) ring of the disc, the soft nucleus pulposus can protrude into the spinal canal. This common and painful disorder is called a herniated disc (also known as a ruptured disc or a prolapsed disc). The protrusion of the nucleus pulposus can press on a nerve root or the spinal cord. The damaged disc can also leak fluid, which may inflame nerve roots. For this reason, herniated discs can become extremely painful.
When a herniated disc occurs in the mid-back, it can be extremely serious. The smaller spinal canal in the thoracic (mid-back) region leaves very little space around the spinal cord. In severe cases, the pressure of a herniated disc on the thoracic spinal cord can lead to paralysis below the waist. Fortunately, most herniated discs happen in the lumbar or cervical spine, where the spinal canal is larger and paralysis is less likely.
Herniated Disc Disease Symptoms
If you have a herniated disc, you may feel pain in more than just your back. Because nerve roots carry signals throughout the body, a herniated disc that compresses a nerve root can cause pain elsewhere. For example, a herniated disc in the lower back may compress the sciatic nerve root, causing the pain and/or numbness known as sciatica, which runs down the back of the leg. A herniated cervical disc, on the other hand, can cause neck and arm pain. In fact, the hallmark of a herniated disc is radicular pain—pain that runs down into the arm or leg. You may also feel numbness or weakness in these areas.
Potential Causes of Herniated Disc Disease
Regular wear and tear, degeneration, and trauma can all cause a herniated disc. Like muscles and ligaments, discs heal from a tear by forming scar tissue, which is weaker than normal tissue.
A traumatic event can put too much pressure on a disc all at once, causing a sudden rupture. If you fall from a ladder and land in a sitting position, it can put tremendous pressure on your spine, which can result in a broken vertebra or a ruptured disc. A smaller amount of force can also rupture a disc, especially if the tough outer ring (annulus) has been weakened by repeated injuries that have added up over time. Once a disc is weak, it can rupture when you lift or bend, or do something that wouldn’t have caused a problem five years earlier. Aging can make discs more vulnerable to ruptures and is the most common cause of disc herniation in the thoracic spine.
Diagnosing Herniated Disc Disease
To diagnose a herniated disc, your Mount Sinai doctor will begin with a medical history and physical exam. We may also use an imaging test, such as magnetic resonance imaging (MRI) to provide additional information.
Herniated Disc Disease Treatment
Your symptoms dictate how we treat your herniated disc. Since most herniated discs heal without surgical treatment, we may first suggest careful monitoring. If your symptoms improve, you may need no other treatment. But if your symptoms get worse, we may recommend surgery.
We may prescribe rest and observation to monitor the progression of the problem. Depending on how much pain you have, we may prescribe medications, and/or physical therapy. If you have severe pain from nerve root irritation, we may prescribe an epidural steroid injection, which is effective in about half of all cases.
Surgical Treatment for Herniated Disc Disease
If you need surgery, we will develop a treatment plan based on your individual symptoms and condition. The traditional surgical treatment for a herniated disc is a combination of laminotomy and discectomy. We perform a laminotomy by cutting an opening in the covering of the disc (lamina) to relieve pressure on the affected spinal nerves; a discectomy removes the herniated disc. Microdiscectomy achieves the same results as traditional discectomy, but it uses a less invasive technique, which speeds recovery. Endoscopic discectomy is an even newer, more technologically advanced version of the microdiscectomy.