Herniated Disk

– The information has been reviewed by Dr. Ng Hung Kwong, Tommy

In recent years, herniated disks have been seen in more and more young people, with the highest prevalence among those aged 30 to 55. Compared to other types of lower back pain associated with problems in the muscle or soft tissues, a herniated disk can cause pain that is more severe.

What is a Herniated Disk?

Spinal disks are soft, cartilaginous joints located between vertebrae in the spine. Spongy and rubbery, the disks protect the nerves and act as shock absorbers. If the spine is overly twisted or finds itself in a poor posture during heavy lifting, it may be subject to excessive pressure, which may lead to a tear in the exterior portion of a spinal disk (annulus) and allow the internal portion of the disk (nucleus) to bulge out. This may then compress nearby nerves and tissues, such as the sciatic nerve, and cause various symptoms such as lower back pain.

Symptoms

Disk herniation may be classified as acute or chronic, and is generally associated with disk degeneration. As the condition develops over a long period of time and may not immediately compress on a nerve, most cases of herniated discs are not accompanied by severe symptoms. If there is a sudden tear that causes a disk to bulge out or rupture and press on the nerves, severe symptoms such as the below may arise:

Sciatica
Spinal stenosis: numbness while walking
In severe cases, patients may experience paralysis or incontinence

Causes + Risk Factors

Disk herniation is commonly associated with aging, sports-related injuries, or injuries caused by twisting and falls. Poor posture, being overweight, and consistently lifting heavy objects can also increase the pressure on spinal disks and accelerate degeneration. Furthermore, a lack of regular exercise may prevent blood vessels from properly reaching the spinal disks. This also leads to early degeneration of the spinal disks as the blood vessels are unable to deliver the necessary nutrients and remove waste products.

Risk Factors

Family history
Being overweight
Previous injury
Smoking (risk of disk degeneration in smokers is four times higher than that of non-smokers)
Poor posture
Lack of exercise

How is a Herniated Disk Diagnosed? + Treatment

The most common symptom of a herniated disk is lower back pain. If lower back treatment does not alleviate the patient’s symptoms, and he/she also experiences symptoms of sciatica, the doctor may recommend an MRI to determine whether there is a tear or herniation in the spinal disk, and examine how this may be affecting the dural sac or nearby nervous tissues. As MRI technology does not involve the use of radiation, the diagnostic process is very safe.

Treatment

Most cases of disk herniation involve structural issues in the spine, such as chronic degeneration. If symptoms are not severe, or if the spinal canal is only slightly narrowed, the patient may only need adequate rest and appropriate exercise to manage the condition. The body may be able to secrete enzymes that naturally resolve the herniation, and patients may experience symptom relief within four to six weeks. Treatment of herniated disks generally focuses on pain relief, and may include medication, physical therapy, and surgery. In severe cases, surgery may be the only treatment option.

Medication	The doctor may prescribe pain medication and muscle relaxers to help relieve symptoms. If the patient is suffering from nerve-related pain, the doctor may prescribe neuropathic drugs.
Physical Therapy	Specific exercises and positions may be recommended to help reduce inflammation and relax the muscles.
Surgery	In severe cases where a nerve is compressed, the doctor may recommend minimally invasive surgery to release pressure on the spinal nerves. Patients generally recover quickly, but will need to avoid strenuous work or exercise and stretch regularly to maintain lower back health. In very severe cases where the spinal cord is displaced, spinal fusion or lumbar disk replacement surgery may be required.

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