Spinal Disc Herniation

Spinal disc herniation is a quite common cause of back pain and pain of the lower extremities. It is quite frequent in patients hospitalized in neurological wards. The condition is not only unpleasant, but it also poses a serious health threat.


The spinal disc is a fibrous structure located between the vertebral bodies. The discs are flexible and allow the spine to bend. However, parts of these discs may prolapse into the surrounding area, which can lead to narrowing of the spinal canal (space behind the vertebral bodies, where the spinal cord is located) or to compression of nerve roots that laterally leave the spinal cord throughout its course.


Spinal disc herniation


Scheme - Herniated disc compressing the spinal canal


The actual cause of the herniation may not always be clear. There may be some genetic predisposition, which is combined with outer factors such as manual labor (lifting heavy objects, frequent bending, etc.). Aging is another risk factor. With advancing age, the flexibility of discs decreases and the risk of herniation is higher. The lack of exercise is also undesirable. Untrained vertebral muscles do not support the spine properly and increase the overload of vertebrae and spinal discs.


The symptoms depend on the exact location of the herniation. The herniation may occur in virtually any location of the spine, but it is most typical for lumbar and cervical intervertebral discs. Cervical spine is also rarely affected. The herniation in this place causes pain of the neck extending into one or both upper extremities. The sensation and motility of the upper extremities may be reduced and tingling sensations may occur. In affection of lumbar spine, the pain in the back may irradiate into one or both lower extremities and it may be accompanied by numbness and paralysis. When the herniation occurs in the lower part of the spinal cord, the affected person may suffer from difficulties in urination and during bowel movements (due to disorders of sphincter innervation).


The diagnosis is based on the medical history and careful neurological examination. Skilled neurologist is usually able to fairly accurately state the precise location of the spinal irritation. However, the herniation must be confirmed by imaging methods. The X-ray of the spine is rather effective in excluding other causes (vertebral fractures, vertebral bone growths, bone metastases, etc.). Computed tomography of a spinal segment is much more effective, but the most accurate and reliable method is the magnetic resonance imaging. The degree of affection of the peripheral nerves (most commonly nerves of the legs) can be evaluated by examination of neuromuscular transmission (electromyography).


There are basically two methods of treatment. The first is conservative approach consisting of medication and rehabilitation, the other option is surgery. The final approach is based on decision of neurologists and neurosurgeons.


Administered drugs include various combinations of pain medications. These may be used chronically as oral drugs, but in case of deterioration, it is also possible to administer them as special intravenous analgesic infusions. The drugs are combined with long-term careful rehabilitation, which aims to reduce the difficulties and strengthen the supporting muscles of the vertebral column.


Surgical treatment is performed in neurosurgical departments. The procedures are quite extensive and performed under general anesthesia. Operational risks include subsequent bleeding and the possibility of infections. Given that the surgery is in close proximity to the spinal cord, there is also present (fortunately, very small) risk of permanent paralysis.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources