Herniated Disc
(Disc Herniation of the Spine)

Herniated Disc Summary
A herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, antiinflammatory medications, muscle relaxants, and surgery.
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Herniated disc facts

  • The discs are pads that serve as "cushions" between the vertebral bodies, which minimize the impact of movement on the spinal column.
  • Each disc is designed like a jelly donut with a central softer component (nucleus pulposus).
  • Abnormal rupture of the central portion of the disc is referred to as a disc herniation.
  • The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumbar vertebrae in the low back.
  • If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation.
  • The physical examination, imaging tests, and electrical tests can aid in the diagnosis of a herniated disc.
  • Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle relaxant medications, pain medication, anti-inflammation medications, local injection of cortisone (epidural injections), and surgical operations.

How are the spine and its discs designed?

The vertebrae are the bony building blocks of the spine. Between each of the largest parts (bodies) of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back (thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In addition, in the mid-buttock, beneath the fifth lumbar vertebra, is the sacrum, followed by the tailbone (coccyx).

The bony spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a spinous process, which is a bony prominence behind the spinal cord that shields the cord's nerve tissue. The vertebrae also have a strong bony "body" in front of the spinal cord to provide a platform suitable for weight-bearing.

The discs are pads that serve as "cushions" between the vertebral bodies that serve to minimize the impact of movement on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus). Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.

Medically Reviewed by a Doctor on 8/1/2012

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Learn if a cortisone injection can reduce the need for surgery to treat a herniated disc.

Epidural Cortisone Injections for Sciatica From Herniated Disc...Beneficial?

Medical Author: Medical Author: William C. Shiel Jr., MD, FACP, FACR

The discs of the spine are located between the vertebrae (bony building blocks of the spine). The disc is designed somewhat like a jelly donut being composed of an inner gelatin-like core (the nucleus pulposus) surrounded by a firm outer ring (the annulus fibrosus).

When the disc structure wears, because of processes such as aging or trauma, it becomes weakened and susceptible to injury. In this condition, stresses on the spine can cause the inner core to protrude outward through the boundary of the disc's outer ring. The is referred to as herniation of the disc.

Disc herniation can directly press upon the spinal cord and/or adjacent nerve tissues resulting in pain which radiates outward from the spine in the distribution of the affected nerve. When the disc herniation is in the spine of the lower back, it can cause a radiating pain down the legs, commonly referred to as sciatica.

A majority of patients with sciatica from disc herniation have resolution of their pain with various conservative measures, including antiinflammatory and muscle-relaxant medications, exercises, physical therapy, and time. However, some 10%-15% of affected patients require surgical procedures to relieve the pain.

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