A disc herniation means that a disc is ruptured. For teaching purposes, please note that the terms disc herniation, disc rupture and disc extrusion all have the same meaning. Disc herniations most commonly occur in middle aged people with the majority of those being identified in individuals in their 40s and 50s. There is a component of the aging process associated with some degeneration that predisposes discs to rupturing.
Disc herniations can and do occur spontaneously. A disc herniation does not have to be physically provoked from a lift, twist or slip or fall event. A person can wake up with a disc herniation.
It should also be noted that trauma can cause a disc herniation, such as a motor vehicle accident. A lifting injury can also cause a disc herniation.
The clinical history of a disc herniation patient includes acute onset pain in the midline of the neck or low back. A disc goes from being intact to ruptured in a fraction of a second and therefore there should be a medical history of acute onset pain. The spine is in the midline. Therefore, the complaint of pain related to a disc herniation should also be in the midline. In other words, low back pain far off to the right or left side in the flank region would not be considered disc-related.
Disc herniation pain in the low back is worse with the patient seated since the seated position generates the most amount of force on the low back. Lying down generates the least force on the low back since the weight of the upper half of one’s body is off the low back. In regard to cervical disc herniations, such pain is worse with the neck in extension (looking up) which compresses the posterior (back) portion of the disc that has ruptured causing an increase and/or reproduction of cervical pain.
Not all disc herniations are accompanied by radiculopathies (“pinched nerves”). Disc herniations can and do often resorb with time. Research has indicated that Mother Nature is just as good at healing a disc herniation as is surgery but usually not for several months to a few years. The purpose of surgery for a person with a disc herniation is to rescue an injured nerve root that is at risk of permanent, intractable pain and/or permanent weakness of the adversely affected limb.
Appropriate conservative treatment options for disc herniations include anti-inflammatory prednisone medication by mouth, non-steroidal anti-inflammatory medication by mouth, pain medication, epidural steroid injections under fluoroscopy, traction and spine stabilization exercises with an emphasis on avoiding cervical and lumbar extension but rather instead minimizing the lordotic curve to maximize nerve root space. Surgery is considered an appropriate treatment option for those with intractable pain and/or weakness and a clinical history and physical examination findings consistent with the disc herniation identified by MRI.