Disc herniation

Disc herniations are also known as slipped, bulging or ruptured discs.

The human spine is made up of 33 vertebrae, including five that are fused to form the sacrum and four that form the tailbone. The remaining vertebrae are separated by discs, sac-like cushions made of cartilage. They act as joints, making the spine flexible, and as tendons, holding the spine together.

Each disc has a tough outer layer (annulus fibrosus), and a spongy inner core (nucleus pulposus) that absorbs shock to the spine. Over time, the disc can degenerate and/or tear allowing the inner core of the disc to be squeezed out. These extrusions can press on surrounding nerves and cause intense pain. The pain may be felt at the site, or it may radiate down the nerve and be felt as pain or numbness in the arm or leg.

The most common sites for herniated discs are in the lower, or lumbar region, of the spine. When this occurs, a common symptom is shooting leg pain, often called sciatica. Disc herniations in the neck, or cervical region, may cause pain, tingling, or numbness in the shoulder, arm, or hand.

In some cases, a disc can herniate without causing pain or other symptoms. In others, even a small herniation can cause significant pain.

Your spine center doctor will conduct a thorough medical history to find out when your pain started, how it progressed, and which movements and treatments have helped or worsened your symptoms.

Your physical exam may include tests to determine weakness, numbness and positional factors that will confirm the presence of a herniated disc.

Additionally, magnetic resonance imaging (MRI), or computerized tomography (CT scan) images may be used to confirm an anatomical lesion, and to provide more information about the location of the involved disc(s) and nerves.

Treatment options for patients with herniated discs are highly individualized, depending on the source and severity of pain.

All spine center physicians recommend conservative, non-invasive treatments whenever appropriate. However, in some cases, early surgical intervention can prevent long-term nerve damage and is therefore the best course of action.

Conservative approaches may include any combination of ice or heat treatments, physical therapy, pain medication, spinal manipulations and patient education about proper body form during exercise or work.

Oral steroids and epidural injected steroids can also be used to reduce inflammation and may provide significant pain relief. If satisfactory results are not achieved with conservative approaches after a given amount of time (usually six to eight weeks), you may be advised to consider other options.

Many patients with lumbar disc herniation have excellent results from microdiscectomy (or microdecompression) surgery. This is a minimally invasive procedure that removes the herniated portion of the disc.

Depending on the location and severity of your disc herniation, your spine center physician may recommend a surgical approach to relieve your symptoms and to avoid future complications. UC Davis Spine Center surgeons are among the best in the country and treat thousands of patients each year with the latest technology and innovations. They will describe all of the surgical options available to you. Together, you both will determine the approach that is best for you.