Spinal disc herniation is when a part of the nucleus pulposus (jelly part of the disc) leaks out of the disc. This occurs through a fissure in the fibrous sheath of the disc called the Annulus Fibrosus.
What is the cause?
Under normal conditions, the normal process of disc wear causes some of the fibres that make up its fibrous sheath to lose resistance and elasticity, and may retract or split spontaneously. When that happens, part of the gelatinous content of the disk or nucleus pulposus can protrude outside.
In some cases, the pressure inside the disc may exceed the resistance capacity of the fibres of the fibrous envelope. As a consequence, the parts and a portion of the disc protrude.
What are the symptoms?
The nucleus pulposus of the disc contains substances that irritate the nerves. Under normal conditions, there are no nerves inside the disc, so these substances do not have nerves to irritate. Usually, there are only nerves in the outer part of the fibrous sheath, and especially in the lateral portions of its posterior wall.
If the hernia occurs in a place in the fibrous sheath where there are no nerves and its volume is small enough not to compress the nerve root, the hernia may not cause pain or discomfort at any time.
On the contrary, if the nucleus pulposus is herniated in a place where there are nerves, the substances it contains cause back pain, in the cervical or lumbar area depending on where the hernia occurred.
Hernias that do not compress a nervous structure are irrelevant and do not constitute a disease, but a “variant of normality”, so they do not require treatment.
Depending on the specific situation, during the painful episode, the following can be used:
- Anti-inflammatories to counteract the inflammation of the disc that causes the hernia and accelerates its volume loss.
- Analgesics to improve pain.
- Muscle relaxants to reduce muscle contracture.
- Start exercising when pain allows it.
When is surgery necessary?
Surgery should only be considered in those herniated discs that cause compression of a nervous structure, and in which the conservative treatment is not effective or the compression is so severe that it can not be treated.
Surgery is only necessary in the following situations ;
- Cauda Equina syndrome. Pressure on nerves that supply the bowel or bladder
- Brown Sequard syndrome. Pressure on part of the spinal cord causing a discrepancy between one and other side of the body
- Severe, unrelenting pain that cannot be relieved by other means
- Spinal cord or nerve compression causing neurological damage ie numbness or weakness
- There is still a very important loss of strength that is not starting to recover because if the compression of the nerve root is important and is maintained for a long time, it can leave permanent sequels.
In cases of disc herniation in which surgery is indicated, the preferred technique is microdiscectomy, which consists of removing only the part of the herniated disc that is compressing a nerve structure. Percutaneous discectomy is another option.
At The London Spine Unit, The Harley Street Hospital, we have many treatment options for herniated discs. We treat 95% of disc herniations without surgery. Our specialists are some of the UK’s best consultants who perform these procedures. Book an appointment to get a check up.