Spinal herniation

Autor: RAFAŁ CZEPUŁKOWSKI
Consultation ŁUKASZ BARTOCHOWSKI
Date added 25.12.2024
Date of last revision 25.12.2024

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Spinal herniation is a serious condition associated with acute or chronic pain, which can lead to significant mobility limitation and neurological problems. Often referred to as a disc prolapse, spinal herniation is associated with the protrusion of the nucleus pulposus of the intervertebral disc outside the intervertebral space with pressure on the spinal cord or nerve roots.

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What is a spinal herniation?

The human spine consists of 24 vertebrae stacked on top of each other. Inside this anatomical structure is the spinal canal, in which the spinal cord and nerves run. Between the vertebral bodies are intervertebral discs, or flexible discs - a nucleus pulposus surrounded by a fibrous ring. These discs are flat and round, and their role is to provide cushioning when walking or running. Unfortunately, with age or as a result of significant stresses, not least from sports, they lose their elasticity and change position, causing a spinal herniation (erroneously called a spinal herniation). It involves the extrusion of a fragment of the nucleus pulposus inside the disc through a ruptured or torn fibrous ring. Patients often ask their doctor about “spinal herniation rupture.” As the disc moves toward the spinal canal, it puts pressure on the nerve structures, which causes pain, most often in the lumbar region - hence the lumbar spine herniation, and in some cases gives neurological symptoms. This undoubtedly has an impact on lifestyle. Spinal herniations can occur in any part of the spine, but most often occur in the lower back - lumbar herniation. Spinal herniation is a common medical problem, most often affecting people between the ages of 35 and 50. Herniated cervical spine is slightly less common, as is herniated thoracic spine.

What are the symptoms of spinal hernia?

Spinal hernia symptoms are very characteristic. In the beginning, usually the symptoms of spinal herniation start for no apparent reason. Patients may experience discomfort in very different ways, which mainly depends on the location and size of the herniated disc. If the disc is not pressing on the nerve, the patient may experience only mild back pain or no pain at all. If there is pressure on the nerve, the typical symptom becomes pain, as well as numbness or weakness in the area of the body where the nerve reaches. The most common symptom is irritation of the sciatic nerve (sciatica). This is pressure on one or more nerves that causes spinal pain, burning, tingling and numbness, often radiating through the buttock to the foot. Spinal herniation can aggravate symptoms especially when sitting, standing, or walking. Most often the ailment affects one side (right or left). Lumbar pain (lumbar herniation) is often described by patients as very sharp, even compared to electric shock. Exacerbation of pain can be caused by laughing or sneezing, as well as improper body position, such as leaning forward and hunching when sitting in a chair.
For the cervical region, a herniated cervical spine can cause dull, sometimes sharp pain in the neck or between the shoulder blades, radiating down the arm to the hand, neck stiffness. The pain may worsen with certain positions or head movements. A fairly rare thoracic hernia gives pain with radiation along the course of the ribs, causing abnormal sensation of muscle weakness in the lower extremities.

Causes of spinal herniation

Herniated discs can result from either obvious trauma or repeated overloading of the spine. Spinal herniation is often associated with the natural degeneration of the disc with age, when the fibers that make up the disc begin to weaken. As this condition develops, a relatively small deforming or twisting motion can cause the disc to rupture. Some people may be more susceptible to disc problems than others. They may suffer from herniated discs in several places along the spine. Studies have shown that one can also be predisposed to spinal herniation when the problem has already occurred in other family members.

Herniated discs in the spine, including often herniated discs in the lumbar spine, can cause dangerous neurological symptoms in addition to pain, including: numbness, muscle paresis or paralysis, and problems with controlling urination and bowel movements. In such a situation, it is important to contact a doctor as soon as possible, as surgery may be necessary in the treatment process.

Factors that increase the risk of developing spinal hernia:

  • age - it most often affects people between the ages of 35 and 50,
  • gender - the risk of occurrence is twice as high in men,
  • obesity - being overweight increases the likelihood of developing a hernia,
  • physical labor - requiring lifting, pulling or pushing heavy objects,
  • cigarette smoking - nicotine restricts blood flow around the discs, which accelerates their degeneration,
  • genetic conditions - hereditary tendency to degeneration of discs.

Cervical spine herniation

Cervical spine herniation can be caused by: degeneration - an aging disc that becomes less flexible and durable, or trauma - a direct blow to the spine causing a ruptured or herniated disc. The main symptom is neck pain radiating to the arm, sometimes causing numbness or weakness in the arm. Pain caused by a herniated disc in the cervical spine can be short-lived or become chronic and last for several months. The pain worsens with certain head positions or when performing specific activities. They tend to worsen during sports activities.

In most cases, herniated cervical spine can be effectively treated with non-surgical methods, such as: pain medications, physiotherapy, stretching and strengthening exercises for the neck, as well as avoiding painful positions and head movements. If there is pain lasting longer than 6 to 12 weeks and non-surgical treatment does not have the desired effect, cervical spine surgery may be necessary. The goal of cervical disc herniation surgery is to remove the damaged disc and provide decompression of the spinal cord.

Is it possible to work with a spinal herniation?

Herniated intervertebral discs in most cases affect home and work life. It can limit mobility and cause excruciating pain, which significantly reduces the ability to perform daily tasks and at work. Severe pain originating from the intervertebral disc can radiate down the limb all the way to the foot, significantly limiting the ability to stand or walk.

With a spinal herniated disc, it is difficult to perform a variety of occupational tasks, such as performing construction, manufacturing and warehouse work that requires regular lifting and carrying of heavy objects. Severe pain caused by a herniated intervertebral disc prompts the use of painkillers, which cause side effects, such as dizziness or drowsiness, which can make it impossible to drive or operate machinery.

It also happens that a spinal herniation does not bring any symptoms, which theoretically does not give a contraindication to doing, for example, office work. However, it is worth consulting an orthopedist or neurologist in such a situation.

Can a spinal hernia be cured without surgery?

Treatment of spinal herniation, in most cases, does not involve surgery. Approximately 90% of people who experience the condition may experience no symptoms or much less discomfort after about six weeks, even if they do not receive specialized medical attention. Symptoms subside because changing hydration can cause the intervertebral disc to shrink. A herniated intervertebral disc at a smaller size reduces the risk of irritating a nerve root. However, functioning with this pain, to easy is not. Therefore, a medical consultation is advisable. A physical examination is crucial for diagnosis. It usually involves observing the patient, checking the range of motion. In a neurological check, the doctor looks for signs of numbness and sensory weakness in the leg and foot. One typical test is the Lasegue test, which checks whether a herniated lumbar spine produces pain symptoms. In this test, the patient lies flat on his or her back, and the doctor gently lifts the straightened lower limb until the patient feels pain. The test is considered positive if the pain occurs when the limbs are raised to 50-60 degrees.

Spinal herniation in the first stage of treatment is most often conservative. The basis for treating the condition is to limit previous activity for a few days to a few weeks. In a situation where the herniation causes spasm in the muscles of the lower back, this sudden pain can be attempted to alleviate. Rest is advisable, lying flat on the back with a pillow under the knees. Sometimes the application of heat can help relieve painful muscle spasms. Heated pillows (thermofors), hot compresses and hot baths are recommended. Read more about rehabilitation and exercises for the spine in our other article. As for lying in bed, this type of rest for severe pain especially in the lumbar region is best limited to one or two days. Lying down longer can lead to stiffness and even more pain. If the back pain is mild, your doctor may administer nonsteroidal anti-inflammatory drugs like Ibuprofen or Naproxen. A physiotherapist can also come to the rescue, showing rehabilitation exercises and teaching how to safely perform ordinary activities like walking or lifting objects from the ground. Patients experience improvement in their pain within a few days to a few weeks after the first symptoms that a spinal herniation gives.

Very important in cases of spinal herniation is diagnosis. The most commonly used technique is magnetic resonance imaging (MRI), which provides an in-depth assessment of the lumbar spine area, showing where the herniation has occurred and which nerves are affected. In contrast, a herniated intervertebral disc (disk) is not visible on an X-ray. Spinal X-rays are performed to find other causes of pain or to indirectly evaluate the space where the discs are located.

Spinal herniation surgery

If a spinal herniation causes pain and other lumbar symptoms that persist six weeks after conservative treatment, surgery is considered. Spinal herniation surgery is also recommended when there is severe pain or numbness and the patient has difficulty standing on his or her feet and walking, regardless of the duration of the condition. A lumbar spinal hernia treated with surgery has a high success rate. Its goal is to make the lumbar herniated disc stop pressing and irritating the nerves, causing pain. The procedure, which is called a discectomy, involves removing part of the herniated disc. The procedure is performed under general anesthesia. The patient lies face down on the operating table. The surgeon makes a small incision in the skin and then pulls the muscles away from the spine. The herniated disc and any loose pieces are removed so that they no longer press on the nerve.

The vast majority of patients do not experience any complications after discectomy. However, bleeding, infection or nerve damage are rare. It is also possible for the disc to rupture again and cause pain symptoms. After spinal herniation surgery, patients can get out of bed very quickly and walk around for a while. Most go home within 24-48 hours after surgery. After leaving the hospital, for the first 4-6 weeks, prolonged sitting, leaning forward and, of course, lifting objects off the ground should be avoided. An important step in returning to full function is rehabilitation. You should contact a physiotherapist, who, after checking your personal data and hospital discharge, will prepare an exercise schedule. After the operation and undergoing all the rehabilitation, the spinal herniation should no longer cause pain.

Related articles:

Learn about other possible causes of spine problems.

Bibliography:

Autor
RAFAŁ CZEPUŁKOWSKI
RAFAŁ CZEPUŁKOWSKI

Specjalista do spraw content marketingu, dziennikarz sportowy i medyczny. Redaktor naczelny magazynu „Poradnik Zdrowie i Sport”, członek Dziennikarskiego Klubu Promocji Zdrowia, współtwórca wielu artykułów medycznych z zakresu ortopedii i urazowości w sporcie.

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Konsultacja merytoryczna
ŁUKASZ BARTOCHOWSKI
ŁUKASZ BARTOCHOWSKI

Lekarz w klinice Rehasport, specjalizuje się w ortopedii i traumatologii narządu ruchu z ukierunkowaniem na leczenie chorób kręgosłupa. Szczególną uwagę poświęca dwóm schorzeniom: kręgozmykowi oraz kręgoszczelinie. Wykonuje m. in. zabiegi ALIF, artroplastykę lędźwiową i szyjną.

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