what is a herniated disc?

A herniated disc occurs when the soft gelatinous core breaks through the outer fibrous ring of an intervertebral disc and flows out into the spinal canal. The typical pain occurs when the gelatinous mass presses on the surrounding nerves and irritates them.

If the intervertebral disc bulges, the outer fiber ring is only partially torn. As a result, the cartilage can no longer hold the intervertebral disc in its original shape, it bulges out and protrudes into the spinal canal. There it can press on the nerves and cause pain. However, the gelatinous core does not emerge. 

A herniated disc (doctors also refer to it as a herniated disc) most commonly develops in people between the ages of 30 and 50. The disease can also develop at a young age and afflict 18 or 20 year olds. Obesity and lack of exercise do not even have to be present, which are the two main risk factors. The spine problems can also be caused by permanent improper stress (for example through sport) or a genetic predisposition. Most of the time, those affected also have weak connective tissue.

Herniated disc: The soft gelatinous nucleus breaks through the outer fibrous ring of the intervertebral disc and flows out into the spinal canal and presses on the nerves 

Spine anatomy: how is the intervertebral disc constructed?

The human spine consists of 7 cervical vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae. So that this central support can react flexibly to steps or jumps, it has a small flexible shock absorber between two vertebrae: the intervertebral disc. The spine has a total of 23 intervertebral discs. If weight presses on the back, these shock absorbers are compressed, cushion the pressure and then distribute it, weakened, to the adjacent vertebrae. To ensure that this works well, the intervertebral disc has a special structure: It consists of a firm outer fiber ring containing collagen fibers and a soft gel-like core.

In order to remain elastic, the intervertebral disc needs fluid. Most of the tissues in the body obtain fluids from blood vessels. But things are different with the intervertebral disc: it is not supplied by blood vessels, but receives water and nutrients from the surrounding tissue. And for that, physical activity is necessary. With every step that a person takes, the stress on the intervertebral disc kneads fluid and nutrients into the shock absorber - the buffer absorbs this elixir like a sponge.

A lack of exercise means that the intervertebral disc does not get enough fluid, making it flatter, brittle and cracked.

Lumbago or a slipped disc?

In the case of lumbago (also known as lumbago in technical terms), the person affected feels a strong, shooting pain in the lower back, which can radiate into the leg. The symptoms are usually so excruciating that the person can barely move. Since the pain arises suddenly and violently, it was believed in the Middle Ages that a witch shot the person affected with an arrow in the back, hence the term "lumbago".

Typical triggers are awkward movement, heavy lifting or unfamiliar bending. Lumbago is usually preceded by a prolonged lack of exercise and thus a weakening of the back muscles. One wrong movement is often enough for the pain to hit you in the back.

The cause of lumbago can also be a herniated disc in the lumbar vertebra area, in which the sciatic nerve is pinched. If pain and sensory disturbances such as tingling or numbness develop in the leg, those affected should contact a doctor immediately. 

Recognizing a slipped disc: what are the symptoms?

A herniated disc does not always cause clear symptoms such as pain or paralysis. Often it even goes without complaints. The pain only occurs when the intervertebral disc presses on the surrounding nerves or the spinal cord.

Most often, in around 90 percent of all cases, herniated discs occur in the lumbar spine (lumbar spine). Here the body weight exerts particularly strong pressure on the vertebrae and intervertebral discs. Such a lumbar disc herniation usually occurs between the 4th and 5th lumbar vertebrae (L4 / L5), as well as between the 5th lumbar vertebra and the sacrum (S1). The mechanical stress is highest in these areas.

In some cases, the cervical spine (cervical spine) is affected, doctors refer to this as a cervical disc herniation. It usually develops between the 5th and 6th or between the 6th and 7th cervical vertebrae. A herniated disc very rarely develops in the thoracic spine (thoracic spine) area.

Depending on where the herniated disc occurs, different symptoms occur:

Herniated disc in the cervical spine (cervical spine)

Typical symptoms are stabbing neck pain, headache and pain that radiates into the arm. Tense muscles in the neck and between the shoulder blades also occur, and dizziness is possible. Those affected can feel numbness and tingling, as well as motor disorders in the arms and hands. If the spinal cord is affected, symptoms of paralysis can occur. When these warning signals occur, those affected should consult a doctor quickly.

Herniated disc in the thoracic spine (thoracic spine)

If there is a herniated disc in the thoracic spine area, pain radiating in the form of a belt occurs along the ribs; Occasionally, sensory disturbances in the chest area and motor problems are also noticeable.

Herniated disc in the lumbar spine (lumbar spine ) 

If the herniated disc presses on the sciatic nerve, it triggers a strong, sharp pain in the lower back. The pain can radiate into the buttocks and over the thighs to the knees and soles of the feet. Motor disorders and tingling or numbness in the leg are also possible.
In severe cases, paralysis of the bladder and rectum occurs. The person suddenly has problems controlling urine or bowel movements. A medical emergency! The person concerned should go to the emergency room of a hospital, otherwise there is a risk of permanent paralysis.   

Self-test: Are your intervertebral discs at risk?

Causes of a herniated disc

There are several factors that can trigger a herniated disc:

• Wear and tear with increasing age: As early as the age of 20, the gelatinous core of the intervertebral disc gradually loses the ability to store fluid. If you put your fibrous ring under permanent pressure due to excess weight, poor posture or other factors, the fibrous cartilage becomes increasingly brittle and cracked - the intervertebral disc can slip, the gelatinous core can swell out of the fibrous ring and press on a nerve.
• Overweight: The more pressure there is on the intervertebral discs, the more they wear out. In some overweight people, the shock absorbers are so worn that the vertebral body almost sits on top of the vertebral body, which is very painful.
• Lack of exercise: With every physical activity, important nutrient fluids are pressed into the intervertebral discs. A lack of exercise, on the other hand, means that these buffers do not get enough fluid, lose elasticity and become brittle and cracked. In addition, weak core muscles (i.e. back and abdominal muscles) provide poor support for the spine and also put strain on the intervertebral discs.
• Incorrect strain : Sitting for hours in a rigid posture or a misalignment of the hip joints stress the intervertebral disc on one side over a longer period of time. This promotes premature wear of the body's own shock absorbers and increases the risk of a herniated disc.
• Overload: Carrying objects can put a lot of strain on the back. The classic example: a heavy crate of drinks is lifted from the floor. If you do this with your back bent, you exert eight to twelve times more pressure on your lumbar spine than when you push the lemonade carrier out of a crouch and with your back straight up.
• Stressful sports: Sports such as horse riding and mountain biking, in which the spine is regularly shaken, put pressure on the intervertebral discs. In tennis and squash, the support is twisted, which also carries a risk.
• Pregnancy: The larger the fetus becomes in the womb, the more pressure it puts on the mother's spine. This can lead to a herniated disc during or after pregnancy.

Herniated disc: diagnosis

In many cases, a detailed examination and a neurological check-up are sufficient to diagnose a "herniated disc". The specialist in charge is an orthopedic surgeon, neurologist or neurosurgeon. Careful diagnosis should enable the practitioner to rule out other diseases with similar symptoms, such as peripheral arterial occlusive disease (PAD).

• Examination interview: During a detailed examination, the attending physician will inquire where the symptoms occur (for example in the lumbar region), how they are expressed exactly (for example as stabbing pain, as numbness in the arms), since when the symptoms have existed and whether or not they get worse when moving or when sneezing or coughing. The doctor will ask whether the patient does sport regularly and what kind of sport he does, whether he sits a lot in his daily work and whether there has already been a slipped disc in the family.
• Neurological test : With simple check-ups, the doctor can determine whether a herniated disc may be present. For example, he checks whether the patient can lift his leg up while lying down without pain, whether he can immediately feel light touches on the arms or legs and whether he can squeeze the doctor's hands with normal force.
• X-ray : An X-ray from the front and the side helps the doctor to indirectly determine whether there is a herniated disc. Although the intervertebral discs cannot be shown on an X-ray, the doctor can see whether the spaces between the vertebrae are narrowed or displaced. If this is the case, this can indicate damaged intervertebral discs.

However: A worn or bulging intervertebral disc does not have to be the cause of the health problems. Often such a non-intact intervertebral disc does not cause any discomfort at all. Instead, the back pain comes from other causes, such as strong muscle tension. In very rare, severe cases, a malignant tumor in the spine or in other adjacent areas of the body such as the pancreas triggers the problem. The doctor should clearly clarify the cause of the symptoms in order to initiate the correct treatment.

• Computed tomography (CT) and magnetic resonance tomography ( MRT ): A herniated disc can be recognized immediately on a CT or MRI image. The pictures show exactly in which section of the spine the problem occurs and in which direction the intervertebral disc has shifted. However, these recordings are expensive and are usually only used to substantiate a questionable diagnosis or to discover a suspected tumor in the spinal area. 
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