Overview
Your spine consists of vertebrae, which are separated by intervertebral discs. Disc herniation refers to when the outer layer of the disc ruptures, allowing the jelly-like substance in the middle of the disc to bulge out of the damaged outer rings. The most common causes of disc herniation are trauma and disc degeneration.
Between 60% and 80% of people will experience low back pain at some point in their lives. Disc herniation is one of the most common causes of low back pain and leg pain, and affects mobility, physical function and quality of life.
Symptoms
The symptoms of intervertebral disc herniation depend on the location and the nerves involved. While some patients experience little or no pain, others experience severe and insistent neck or lower back pain. Other symptoms include numbness, tingling, muscular weakness, paralysis, pins and needles and slowed reflexes.
If the herniated disc is in the lower back, the patient may also experience sciatica (pain caused by compressed nerve roots in the sciatic nerve, which extends from the lower back to the back of each leg). Another condition caused by disc herniation is cauda equine syndrome, a serious medical condition which affects the legs and urogenital area.
Diagnosis
To diagnose you, your doctor will need your medical history, a list of your symptoms and to physically examine you. Although X-rays cannot be used to diagnose herniated discs, they may be used to rule out other causes of back pain, such as infection, tumours, spinal alignment issues or fracture.
CT can provide useful information to assess bone, degenerative disc disease, loss of disc height and deterioration of the joint cartilage. MRI provides the most information as the herniated area is clearly visualised. Other tests, such as electromyograms and nerve conduction studies, which measure the electrical activity of nerves at rest and moving, may be used to assess nerve damage if the nerve roots are compressed.
Treatment
You will first be treated with conservative therapies, including rest, physiotherapy, painkillers and anti-inflammatory medication. If these approaches are unsuccessful, however, there are minimally invasive techniques available that can provide effective pain relief for nerve pain caused by disc herniation, such as selective image-guided infiltration with a local anaesthetic and disc decompression techniques.
The aim of disc decompression techniques is to remove a small amount of the jelly-like substance in the centre of the disc, thus reducing pressure between the discs. This can be achieved by using a variety of decompression techniques, such as medication, heat or mechanical devices.
Bibliography
1. Xavier Buy, Afshin Gangi. Percutaneous Treatment of Intervertebral Disc Herniation. Semin Intervent Radiol. Jun 2010; 27(2): 148–159
2. Andreula C, Muto M, Leonardi M. Interventional spinal procedures. Eur J Radiol. 2004;50:112–119.