Spinal disc herniation: Symptoms, diagnosis, and treatment

Leading Medicine Guide Editors
Leading Medicine Guide Editors
The sudden onset of pain radiating from the back to the extremities becomes increasingly intense. A spinal disc herniation or herniated disc manifests with clear symptoms. However, it is not always correctly recognized and treated immediately.

Here you will find additional information and selected doctors for the treatment of spinal disc herniations.
ICD codes for this diseases: M51

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Brief overview:

  • What is a spinal disc herniation? Intervertebral discs that serve as shock absorbers are located between the vertebral bodies of the spinal column. This disc is composed of a gelatinous core, known as the nucleus pulposus, and a fibrous ring called the annulus fibrosus. In a herniated disc, the annulus fibrosus tears and the nucleus pulposus protrudes out.
  • Symptoms: Severe immobilizing pain radiating to the extremities. Tingling and a feeling of numbness often occur.
  • Diagnosis: An MRI or CT scan can be used to visualize the herniated disc and determine its extent. Exact knowledge and a detailed diagnosis are necessary for choosing the appropriate therapy.
  • Causes: Most often, a herniated disc does not occur suddenly. The intervertebral disc is slowly damaged over time until it finally protrudes under load.
  • Risk factors: Lack of exercise, being overweight, an unhealthy diet, and smoking are risk factors for damage to the intervertebral discs. Additional risks include muscle imbalances and probably a congenital weakness of the connective tissue.
  • Treatment: Most incidences (over 90%) can be successfully treated conservatively (without surgery) with rest, physiotherapy, and medication.
  • Surgery: Surgery is necessary if there is no improvement after eight weeks at the latest. In most cases, the intervention is minimally invasive. In this procedure, the surgeon removes the protruding tissue, which relieves the pressure on the spinal cord and/or nerve root.
  • Sick leave: Conservative treatment is accompanied by an inability to work for four to 12 weeks. In the case of surgery, a hospital stay of several days may be followed by three weeks of rehab.
  • Aftercare: It is recommended to start physiotherapy after the fourth postoperative week. When it is possible to exercise again depends on the individual case and the type of sport.

Article overview

Anatomy of the intervertebral discs

The spinal column consists of 24 vertebrae and 23 intervertebral discs between them. These consist of a stable but elastic fibrous ring (annulus fibrosus) and a gelatinous core (nucleus pulposus). The nucleus pulposus is a water-retaining cushion and absorbs stresses on the spine.

Intakte Bandscheibe

Intervertebral discs do not have blood vessels running through them. They receive their nutrients via tissue fluid. If we move, we squeeze out the intervertebral discs like sponges. If we alleviate the pressure on them, they fill up with the nutrient-rich liquid.

Definition of a herniated disc

In a herniated disc, the nucleus pulposus breaks through the annulus fibrosus of the intervertebral disc and presses on the surrounding nerves. The pressure on the nerves causes the pain.

© Henrie / Fotolia

In the video you can see the progression of a herniated disc:

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  • Where does a herniated disc occur?

    A herniated disc can occur in any part of the spine. It often occurs in the lower lumbar spine (lumbar disc herniation) and in the cervical spine (cervical disc herniation).

    Doctors name herniated discs based on their location in the spine: For example, LVK5/CV1 refers to damage to the lumbar spine in the segment between the fifth lumbar vertebra (L5) and the first coccygeal vertebra (S1).

    Variations of intervertebral disc damage

    Damage to intervertebral discs can occur in various forms:

    • Beginning protrusion,
    • Progressive protrusion,
    • Spinal disc herniation, and
    • Sequestration.

© bilderzwerg / Fotolia

The tissue damage causes severe immobilizing pain in a herniated disc, which often radiates to the extremities. Neurological paresthesias often develop as well:

  • Tingling,
  • Heat or cold without external causes,
  • Numbness

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Pain often occurs with exertion. The pain often forces the patient into a pain-reducing protective posture.

Diagnosing spinal disc herniation

The clinical symptoms and the medical history interview provide initial clues. This is followed by a physical and neurological exam.
However, diagnostic imaging is mandatory to resolve suspicion of a herniated disc.

In the X-ray image, the attending physician finds evidence of changes in the bony structures as well as degenerative processes. For the diagnosis and further planning of therapy in the case of a herniated disc, magnetic resonance imaging (MRI) is the method of choice. This can show the soft tissue parts and thus a herniated disc.

Magnetic resonance imaging © digitale-fotografien / Fotolia

Causes of a herniated disc

A damaged disc usually has a longer, unnoticed history. In most cases, the intervertebral disc is gradually damaged more and more until it finally comes to prolapse.

Intervertebral discs dehydrate and become brittle due to:

  • Aging,
  • Lack of exercise,
  • Unbalanced diet, and
  • Smoking.

In addition to being overweight, muscle imbalances, untrained muscles, and unfavorable movements put a lot of strain on the intervertebral discs.

The video shows a possible progression of disc degeneration with secondary damage:

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Spinal disc herniation is a neurological disease with an orthopedic background. Therefore, it exhibits symptoms from both fields.

There are three main causes of disc herniation:

  • A congenital weakness of the intervertebral disc tissue and connective tissue,
  • A sudden "twisting" movement of the trunk with heavy lifting or pushing, and
  • Being overweight combined with muscle imbalances causes an abnormal load on the spine.

Often, a herniated disc occurs when lifting a heavy beverage crate in a stooping posture. In the process, you often turn to put the box in the trunk of your car. This puts a lot of pressure on the intervertebral discs, which give out under the load. Poor muscle condition and being overweight increase the risk. In addition, smoking weakens the disc tissue.

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© #CNF / Fotolia

Herniated disc: What now?

The first thing you should do is lay down and immediately elevate your feet. Your knees should be bent at a 90° angle. There are special foam cubes designed to relieve pressure on your spine. A padded box, stool, or chair will also do. This position creates space between the vertebrae and relieves the compressed tissue.

You can use this versatile first aid for a herniated disc in bed or on the yoga mat. It is important that the spine lies flat and that you can breathe calmly and deeply. The addition of a hot water bottle helps enable relaxation. To stand up from lying down, roll over on your side to protect your back and stand up using support.

Avoid lifting heavy loads at all costs. Seek a qualified doctor as soon as possible.

Stufenlagerung Bandscheibenwürfel
Lying down with elevated feet to relieve a herniated disc © C. Schüßler / Fotolia

Spinal disc herniation: Which doctor?

Specialists for treating herniated discs include orthopedists, spine surgeons, and neurosurgeons. These specialists diagnose and treat herniated discs by means of physical and MRI exams.

Severe cases may require the cooperation of several specialists. Since a herniated disc affects the nerves, the orthopedist may consult a neurologist, for example. If surgery is required, they will consult a spine surgeon, who usually has completed a residency in orthopedics and trauma surgery or neurosurgery.

Herniated disc specialists have undergone many years of training. Prospective specialists must work for several years as a training assistant, for example, in an orthopedic specialty clinic.

Treating a herniated disc

A herniated disc is not always automatically a matter for the surgeon. In fact, doctors and therapists can provide excellent conservative treatment for herniated discs. Spinal disc herniation is associated with pain, nerve compression, and inflammation. The doctor must eliminate these three factors to enable the patient to break out of the pain cycle and ensure that the symptoms do not become chronic.

The healing phase lasts a few weeks to months. During this process, the deformed annulus fibrosus reverts to its original shape in the event of a rupture. The body itself breaks down disc mass that has already leaked out. 90% of all herniated discs are successfully treated in this way.

Conservative treatment of the herniated disc

Sometimes it is enough to rest the back for two weeks with gentle mobilization after a herniated disc occurs. During this time, you should avoid heavy lifting. After that, you should start strengthening the abdominal and back muscles. Here, a physiotherapist should definitely pay attention to the correct selection and performance of exercises. In the case of a herniated disc, the doctor usually prescribes physiotherapy. Rehabilitation sports are also used, depending on the ailment. 

Medication helps against pain, severe muscle tension, and inflammation. The doctor will also prescribe antiphlogistic drugs, that is, anti-inflammatory drugs that reduce swelling from the NSAIDs group (non-steroidal anti-inflammatory drugs). These include the active ingredients diclofenac and ibuprofen. Suitable muscle relaxants include medications containing the active ingredient methocarbamol; these are available on a prescription-only basis. NSAIDs should always be taken with the appropriate gastric protection.

Another treatment option is injection therapy. In this treatment, the doctor injects the pain medication directly into the irritated nerve or the small vertebral joints, the so-called facet joints. The video shows how a pain management with a radio frequency probe works:

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The goal of drug treatment is to relieve pain so that the irritated tissue around the disc can recover. This enables you to perform physiotherapeutic exercises more effectively and discontinue postures that provide relief.

With conservative treatment of a herniated disc, it takes 3 to 6 weeks to achieve initial freedom from pain. It may take several months for the damaged disc to heal completely.

Surgical therapy: Intervertebral disc surgery

Improvement should occur after 6 to 8 weeks. If this is not the case, or if there is significant numbness or muscle weakness (weak dorsiflexion), an intervertebral disc surgery may be necessary. The surgeon will thoroughly consider the benefits and risks of such a surgery with the patient.

The principle of intervertebral disc surgery is to relieve the nerve compression that causes pain. To do this, the doctor removes the prolapsed and, in some cases, separated gelatinous mass from the disc nucleus.

Surgery can be performed endoscopically or openly, i.e., as microsurgery using a surgical microscope under general anesthesia.

The microscope allows the surgeon to see the protruding bone of the vertebral body more precisely and, if necessary, to partially remove it. In each individual case, the doctor and patient decide together on which surgical procedure is suitable and most appropriate.

Endoskopische Mikrodiskektomie des Bandscheibenvorfalls

How long does the pain last with herniated discs?

Pain is the main symptom of a herniated disc. In some cases, paralysis and sensory disorders are also present. However, the question should not be how long this pain lasts. It's more about how long the patient has to live with that pain.

If the pain persists for more than 6-12 weeks, surgery must be considered to prevent chronic pain.

Duration of sick leave in the event of a herniated disc

With conservative treatment of a herniated disc, the patient is unable to work for 4 to 12 weeks. The duration depends on the severity of the clinical picture and how effective the conservative therapy is.

In the case of intervertebral disc surgery, the patient remains in the hospital for a few days. This can be followed by rehabilitation measures.

In the first week after the operation on the intervertebral disc, the patient should move as little as possible. Nevertheless, they should walk a few steps every day. Immediately after surgery, the patient must wear a special support brace.

Stützkorsett Lendenwirbelsäule

Aftercare and rehabilitation for a herniated disc

After about one to three weeks, the patient can begin physiotherapy.

Another follow-up examination is necessary after three months, either at the hospital or with a back specialist of your choice. A muscle test will be performed during the medical examination three months after surgery. If the muscles are not strong enough, a special training program will help.

Can a slipped disc be prevented?

Herniated discs are often caused by disc wear. This depends on some lifestyle factors that you can change through preventive measures. By doing this, you will slow down the wear and potentially prevent another herniated disc.

It is especially important to maintain a normal weight. Being overweight and a lack of exercise put stress on the spinal column and likewise on the intervertebral discs. This accelerates disc degeneration and increases the likelihood of a herniated disc.

Sports that are gentle on the joints contribute to a healthy body weight. In particular, these include swimming, cycling, and Nordic walking. These sports bring movement and activity into your life. At the same time, you will strengthen your back and help it to better cope with everyday stresses again. With this combination, you can better prevent another herniated disc.

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