Herniated Disc
Dr. Bence Moravcsik
Orthopedic-Traumatologist
What is a herniated disc?
The herniated disc is a degenerative – i.e. wear and tear – lesion in a specific part of the spinal column. It most commonly occurs in the lumbar spine and cervical spine and can cause severe pain, numbness or reduced mobility.
The spinal column is made up of vertebrae, between which the so-called intervertebral discs provide the flexible connection. The intervertebral discs are made up of two parts: an outer circular fibrous ring and an inner gelatinous nucleus. The intervertebral discs are the “shock absorbers” of our spine, ensuring the mobility and flexibility of the spinal column.
In a disc herniation, the outer fibrous ring of the disc ruptures and the nucleus pulposus protrudes through it. This is called disc herniation. Prebulging can cause the nerve roots exiting the spinal cord to come under pressure, become pinched and inflamed, and even injured. Damage to the nerve fibres can lead to long-term mobility problems, including paralysis. Without proper treatment and attention, a herniated disc can rupture and cause severe pain and reduced mobility, leading to further nerve damage.
What is the difference between disc herniation and herniated disc?
Disc herniation is also known as a disc herniation. There is no difference in meaning between the two terms.
How is it formed?
The development of a herniated disc is rarely linked to injury or trauma. Most cases develop slowly, gradually, over a period of years. The fibrous rings of the intervertebral discs are elastic due to their high water content. However, the water content of the intervertebral discs steadily decreases after the age of 20-25 years, causing the discs to dehydrate and start to wear. As the water content of the intervertebral disc decreases, the gelatinous inner part behind the fibrous outer part of the disc protrudes, which can put pressure on or damage the nerve roots exiting the spinal cord.
The slow wear and tear process is also greatly influenced by various lifestyle factors, as well as sudden injuries and traumas. Office workers, people with sedentary lifestyles, people who do heavy physical work and athletes are also particularly at risk. Scoliosis and other spinal diseases are an additional predisposing risk.
Diagnostics for spinal hernia
The diagnosis is made by an orthopedics specialist or rheumatologist. At BMM, we have developed a specific patient journey protocol to ensure a thorough examination and effective, targeted therapies.
Our mission is to help our patients regain their freedom of movement as soon as possible, and to permanently and long term relief from painful complaints.
The cornerstones of a successful investigation based on the BMM patient journey protocol:
- The medical history is half the diagnosis, and many diseases can be ruled out by detailed questioning.
- A thorough physical examination by a specialist. On the basis of the physical examination, a specialist will determine the need for any diagnostic imaging tests. Diagnostics tests can help to visualise and measure anatomical structural changes and reveal the true cause of the complaint.
- An X-ray examination of the spine can confirm bony lesions. This is often necessary for isolating purposes related to diagnostics.
- The condition of the soft tissues, discs, articular cartilage, muscles and tendons is accurately assessed by the radiograph.
- An MRI (magnetic resonance imaging) scan is often needed to make an accurate diagnosis of a disc herniation.
- In the case of nerve involvement, neurophysiological testing, ENG or EMG examination is recommended to determine the extent of suspected nerve damage.
Neuroconductive neurophysiological examinations (ENG/EMG) are available at BMM’s clinics in Pest and Óbuda. Necessary spinal X-ray examinations, ultrasound examinations, CT scans and spinal MRI examinations are provided by our partner institutions at an off-site location for an additional fee.
- Based on the medical history, physical examination and imaging diagnostics, the orthopaedic specialist makes an accurate diagnosis.
- A personalised treatment plan is made, including specific spinal physiotherapy.
- The care of this spinal hernia patient is not over yet. Our team of professionals (doctor, physiotherapist, physiotherapist-masseur) will continue to monitor the patient’s condition, help him change his lifestyle and maintain long-term pain-free living.
- We accompany our patients all the way to recovery!
Symptoms of herniated disc
The main symptom of a herniated disc is spinal pain, which is also associated with other symptoms of neurology: numbness, radiating pain, a pins and needles sensation, loss of sensation, possibly incontinence or bowel dysfunction. Symptoms are greatly influenced by the location of the hernia.
Hernia of the lumbar spine
The most common type is lumbar herniated disc, in which the sciatic nerve is affected. The main symptom of lumbar hernia is sciatica. In this case, severe pain in the lower back is accompanied by numbness and a sensation of pain radiating down the legs. One of the most common causes of sciatica is lumbar hernia.
Cervical spinal hernia
Cervical spinal hernia is also a common condition. Pain and numbness radiate to the shoulders and arms, but can also cause headaches, loss of balance or even tinnitus. The pain in the neck is also of the characteristic sharp type, increasing with sudden movement.
Rarely, a herniated disc develops in the middle back. In this area, the ribs provide more support, so the vertebrae and discs in this area are under less strain.
If you have any of the following symptoms of a hernia affecting any part of your spine, you should see an orthopedics, rheumatology or neurology specialist as soon as possible for an examination:
- pain radiating from the spinal cord to the limb
- limb numbness
- emotional disturbance, loss of sensation
- muscle weakness
- an ant-like or pins-and-needles feeling in the limbs
- limb paralysis (even temporary!)
- incontinence, constipation.
Typically, the pain can be triggered by body position or movement, for example, the pain is increased by coughing, sneezing, medical examination techniques.
The key to success is doctor-patient cooperation and trust!
Symptoms of herniated lumbar spine
Herniation most often occurs in the lumbar spine and is called a lumbar herniation. This is the area where the intervertebral discs are subjected to the most stress during everyday life. In sedentary work, it is the prolonged sitting itself that can cause problems, and in sports or physical work, inappropriate lifting techniques can cause problems. The lumbar section of the spinal column in most people is unstable to some degree, making it highly vulnerable. It only takes one wrong movement or even a sustained negative load to develop a lumbar hernia.
A herniated disc in the lumbar region usually affects the sciatic nerve, putting it under pressure or pinching it. The sciatic nerve starts in the spinal cord and runs down the pelvic bone to the legs. In the lumbar region, it passes in close proximity to the lumbar vertebrae and intervertebral discs, so it is easily damaged in the event of a hernia. Pain and numbness radiating into the thighs or legs is the main symptom of this – also known as sciatica.
Lumbar herniated discs require professional treatment as soon as possible – even if the pain and other symptoms are not persistent or do not significantly impair mobility and quality of life. A small herniated disc is also a problem that needs to be treated! With spinal physiotherapy and regular personalised specific exercises, lumbar disc herniation can be managed and even reversed.
Treatment of herniated discs
The treatment of a herniated disc depends on the extent and location of the hernia and the quality of the symptoms caused. In each case, a specialist will decide on the appropriate therapy after a thorough examination.
In most cases, disc herniation can be treated well with conservative therapy . Conservative treatment is led by an orthopedic surgeon, a neurologist or a rheumatologist. Acute pain relief and anti-inflammatory effects are usually achieved with medication, which may be a topical injection, oral or even patch; steroid or non-steroidal. Spinal decompression is also essential in the acute phase, but long-term strict bed rest is not recommended. Nerve mobilisation is recommended to release the pressurised nerve. Long-term conservative therapy is required once the acute pain has subsided. The main element of this is physiotherapy, which should be tailored to the individual. With McKenzie’s spinal exercises, nerve mobilisation training and manual therapy, herniated discs can be managed very well, even achieving complete symptom relief. In addition to physiotherapy, complementary physiotherapy treatments (ultrasound, TENS safe laser), therapeutic massage and balneotherapy are also recommended.
In severe cases, a ruptured disc herniation may require an intervention. This requires consultation and examination by a neurosurgeon specializing in neurosurgery. Herniated disc surgery is performed by a neurosurgeon. Physiotherapy also plays an important role in post-operative rehabilitation and in the way of life after surgery.
How can surgery be avoided?
Even in the case of herniated discs, an intervention can be avoided with regular, professional physiotherapy. By performing individual, tailored and targeted exercises, the deep muscles of the spine are strengthened, reducing the strain on the discs. Spinal physiotherapy should be complemented by therapeutic massage, physiotherapy (ultrasound therapy, TENS, safe laser treatment) or balneotherapy. In addition to therapy, lifestyle also plays a major role in avoiding surgery. In the case of overweight, weight reduction is recommended, as well as avoiding smoking and alcohol, following a healthy diet and drinking plenty of fluids.
The indication for surgery is always decided by a neurosurgeon.
Causes of disc herniation
The development of disc herniation can be caused by several different factors. It is important to recognise the early signs and start treatment in time. If the symptoms persist, it is worth taking them seriously and seeing a specialist in rheumatology or in spine medicine as soon as possible.
Most spinal hernias are caused by a degenerative process, but there are factors that can increase the risk of developing a disc herniation:
- Sedentary lifestyle
- Sedentary work, incorrect sitting, poor posture
- Heavy physical work, poor lifting technique
- Serious sports activity without strengthening the deep back muscles
- Scoliosis
- Ankylosing Spondylitis
- Other spinal diseases
The importance of prevention
The development of herniated discs can often be prevented by lifestyle changes. If you have a known back problem, it is highly recommended that you see a physiotherapist and learn specific exercises to strengthen your deep back muscles. It is also recommended to learn and practice correct posture, sitting posture and lifting techniques.
Regular back massage is also beneficial for the back muscles, reducing the strain on the spine.
With a healthy lifestyle, adequate fluid intake and a diet rich in vitamins and minerals, you can maintain healthy bones, discs, joints and muscles for a long time. Recommended minerals and vitamins.
In addition , regular exercise and sports such as swimming, running, walking are recommended.
Most Common Complaints Treated by Spine Medicine Center Specialists
- lower back pain
- lower back pain
- scoliosis
- nerve compression
- back pain
- neck pain
- stiff neck – neck stiffness
- osteoporosis
- spinal pain
- spinal stenosis
- back pain
- lumbar spine pain
- gluteal muscle pain
- poor posture
- sacrum pain
- shoulder blade pain
- morning lower back pain
- neck pain