and/or Bulging Discs
A spinal disc herniation,
commonly called a "slipped disc", is a medical
condition affecting the spine, in which a tear in the outer,
fibrous ring (annulus fibrosus) of an intervertebral disc
allows the soft, central portion (nucleus pulposus) to bulge
It is normally a further development of a previously existing disc protrusion,
a condition in which the outermost layers of the annulus fibrosus are still
intact, but can bulge when the disc is under pressure.
Some of the terms commonly used to describe
the condition include herniated disc, prolapsed disc, ruptured disc, and
the misleading expression "slipped disc." Other terms that are
closely related include disc protrusion, bulging disc, pinched nerve, sciatica,
disc disease, disc degeneration, degenerative disc disease, and black disc.
The popular term "slipped disc" is quite misleading, as an intervertebral
disc, being tightly sandwiched between two vertebrae, cannot actually "slip," "slide," or
even get "out of place." The disc is actually grown together with
the adjacent vertebrae and can be squeezed, stretched, and twisted, all in
small degrees. It can also be torn, ripped, herniated, and degenerated, but
it cannot "slip."
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Stages of Spinal Disc Herniation
Disc herniation can occur
in any disc in the spine, but the two most common forms are
the cervical disc herniation and the lumbar disc herniation.
The latter is the most common, causing lower back pain (lumbago)
and often leg pain as well, in which case it is commonly
referred to as sciatica.
Lumbar disc herniation occurs 15 times more often than cervical (neck) disc
herniation, and it is one of the most common causes of lower back pain. The
cervical discs are affected 8% of the time and the upper-to-mid-back (thoracic)
discs only 1 - 2% of the time.
The following locations have no discs and are therefore exempt from the risk
of disc herniation: the upper two cervical intervertebral spaces, the sacrum,
and the coccyx.
Most disc herniations occur when a person is in their thirties or forties when
the nucleus pulposus is still a gelatin-like substance. With age the nucleus
pulposus changes ("dries out") and the risk of herniation is greatly
reduced. At the same time osteoarthritic degeneration makes its inroads.
Cervical disc herniation
Cervical disc herniations occur in the
neck, most often between the sixth and seventh cervical vertebral bodies.
Symptoms can affect the back of the skull, the neck, shoulder girdle, scapula,
shoulder, arm, and hand. The nerves of the cervical plexus and brachial plexus
can be affected.
Thoracic disc herniation
Thoracic discs are
very stable and herniations in this region are quite
rare. Herniation of the uppermost thoracic discs can
mimic cervical disc herniations, while herniation of
the other discs can mimic lumbar herniations.
Lumbar disc herniation
Lumbar disc herniations
occur in the lower back, most often between the fourth
and fifth lumbar vertebral bodies or between the fifth
and the sacrum. Symptoms can affect the lower back,
buttocks, thigh, and may radiate into the foot and/or
toe. The sciatic nerve is the most commonly affected
nerve, causing symptoms of sciatica. The femoral nerve
can also be affected. Can cause the patient to experience
a numb, tingling feeling throughout one or both legs
and even feet.
Causes of a disc herniation can include
general wear and tear on the disc over time, repetitive
movements, stress on the disc that occurs while twisting
and lifting, or other injuries.
While the chief complaint for spinal
disc herniation is lower back pain, symptoms of a herniated
disc can vary depending on the location of the herniation
and the types of soft tissue that become involved.
They can range from little or no pain if the disc is
the only tissue injured to severe and unrelenting neck
or back pain that will radiate into the regions served
by an affected nerve root when it is irritated or impinged
by the herniated material. Other symptoms may include
sensory changes such as numbness, tingling, muscular
weakness or paralysis, and affection of reflexes. Unlike
a pulsating pain or pain that comes and goes, which
can be caused by muscle spasm, pain from a herniated
disc is usually continuous.
It is possible to have a herniated disc without any pain or noticeable symptoms,
depending on its location. If the extruded nucleus pulposus material doesn't
press on soft tissues or nerves, it may not cause any symptoms. It has been
estimated that as many as 50% of the population have focal herniated discs
in their cervical region that do not cause noticeable symptoms.
Typically, symptoms are experienced only on one side of the body. If the prolapse
is very large and presses on the spinal cord or the cauda equina in the lumbar
region, affection of both sides of the body may occur, often with serious consequences.
Diagnosis is made by a practitioner based
on the history, symptoms, and physical examination. At some point in the
evaluation, tests may be performed to confirm or rule out other causes of
symptoms such as spondylolisthesis, degeneration, tumors, metastases and
space-occupying lesions as well as evaluate the efficacy of potential treatment
|These tests may include the following:
• Computed tomography
scan (CT or CAT scan)
• Magnetic resonance
and Nerve conduction
Scan of lumbar disc herniation between fourth and
fifth lumbar vertebral bodies.
Main Greensboro Office
3410 West Wendover Aveue Suite A
Greensboro, North Carolina 27407
Phone: 336-274-3500 / Fax: 336-292-1928
© 2010 Salama Chiropractic
Greensboro, North Carolina (NC) Chiropractors, - Oak
Ridge & Winston-Salem