Vertebral column disorders

What is intervertebral disc herniation?

 An intervertebral disc lies between adjacent vertebrae in the vertebral column. It allows slight movement of the vertebrae, and functions as a shock absorber for the spine, e.g. when walking or jumping. Intervertebral discs consist of an outer fibrous ring (Latin – annulus fibrosus), which surrounds an inner gel-like centre (Latin – nucleus pulposus) that acts as a shock absorber.

If there is damage to the disc, the disc tissue can move from its normal seat and press the adjacent nerve structures inside the spine. Localized damage with the displacement of the disc tissue that is limited to less than 25% of the total disc circumference is called disc herniation. A displacement of the intervertebral disc tissue may be smaller or larger and cause milder or more severe symptoms. The most common symptoms are pain and sensory symptoms like numbness or tingling. In more severe cases, muscle weakness or some other neurological symptoms can also occur.  Disc herniation can be further subdivided into protrusions and extrusions.

A disc bulge is another type of intervertebral disc damage.  The difference between a bulge and a herniation is that, in a bulge, a larger part of the disc circumference  (more than 25%) displaces beyond its normal boundaries. Unlike herniation, however, disc bulges are commonly seen in people who do not have pain or any other significant symptoms.

What are the symptoms of cervical disc herniation?

In most cases, the main symptom is pain that radiates down the arm to the hand or fingers. In addition to pain, there is commonly numbness or tingling in the arm or hand. Also, the weakness of hand or arms muscles can be caused by the cervical disc herniation. Typically, certain positions or movements of the neck can intensify the pain and other symptoms. 

In the most severe cases, disc herniation can compress the spinal cord, which can cause arm and leg weakness and urinary control insufficiency. In such cases, an emergency neurological or neurosurgical examination and the appropriate diagnostics (usually urgent  MRI) have to be performed.

What are the symptoms of a herniated disc in the lower back?

Typically, the main symptom is a pain in buttocks, thigh, calf, and sometimes in part of the foot. The pain intensifies with movement and soothes at rest. In addition to pain, people who have a herniated disk often have radiating numbness or tingling in the leg and foot. Such a condition can be called sciatica.

In some cases, disc herniation can also cause legs muscle weakness of varying degrees. In the most severe cases, it is possible that muscle weakness and sensory disturbance can affect both legs.  In such cases, there is often an inability to control the urination. If such symptoms occur, an examination by a neurologist or neurosurgeon should be performed as a matter of urgency.

When is a surgical treatment for sciatica needed?

Surgery is one of the treatment options for sciatica, but it is necessary only in some specific situations. The need for surgical treatment is assessed on the basis of the neurological examination and radiological findings – typically, spinal MRI. The pain can be very severe, but it is only one of the criteria when evaluating the need for surgery. The most important are: disturbance in the control of urination and stool, weakness of the muscles in the legs and severe disturbance of sensation. However, the clinical picture of sciatica is usually less severe than abovementioned symptoms and then surgical treatment is not necessary. I n some situations, there is only a relative indication for surgery, which means that conservative treatment is also a rational choice. In such cases, the patient chooses between conservative and surgical treatment after being informed of the benefits and potential risks of surgical treatment.

What should I do to prevent intervertebral disc damage?

Intervertebral disc lesion is caused by static and dynamic spinal loads that the disc tissue cannot withstand. Excessive dynamic loads of the spine can occur, for example, in rotational movements of the body when playing tennis or football, and when lifting heavy loads incorrectly. Increased static loading of the spine occurs in obese people and in people who sit in inadequate positions for a long time. Those who have had sciatica before should know what could contribute to further disc damage and avoid or correct movement and postures if possible. Exercises aimed at strengthening the muscles of the torso, back and abdomen can be recommended to anyone. Strong trunk muscles make the spine more stable and more resistant to the forces acting on it. There are many portals on the internet that describe muscle strengthening exercises, but it is always best to consult a physiotherapist who will adjust the exercises and their intensity to a specific case and individual’s state and abilities.