During spinal movement, the peripheral anulus bulges slightly posterior during extension, anteriorly during flexion, and towards the side of lateral bending. This is opposite to what some might think. Concurrent with bulging is disc contraction on the contralateral side Poisson effect.
Overview[ edit ] Disc herniation is usually due to age-related degeneration of the outer ring, known as the anulus fibrosus, although traumalifting injuriesor straining have been implicated as well. Tears are almost always postero-lateral on the back of the sides owing to the presence of the posterior longitudinal ligament in the spinal canal.
Disc herniations are normally a further development of a previously existing disc protrusiona condition in which the outermost layers of the anulus fibrosus are still intact, but can bulge when the disc is under pressure. In contrast to a herniation, none of the central portion escapes beyond the outer layers.
Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. Severe herniations may not heal of their own accord and may require surgery. The condition may be referred to as a slipped disc, but this term is not accurate as the spinal discs are firmly attached between the vertebrae and cannot "slip" out of place.
Signs and symptoms[ edit ] 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 pain or low back pain that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material.
Often, herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet. Other symptoms may include sensory changes such as numbness, tingling, paresthesiaand motor changes such as muscular weakness, paralysis, and affection of reflexes.
If the herniated disc is in the lumbar region, the patient may also experience sciatica due to irritation of one of the nerve roots of the sciatic nerve. 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 or at least is continuous in a specific position of the body.
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. This type of pain is usually felt in the lower extremities or groin area.
Radiating nerve pain caused by a prolapsed disc can also cause bowel and bladder incontinence. If the prolapse is very large and presses on the nerves within the spinal column or the cauda equinaboth sides of the body may be affected, often with serious consequences.
Compression of the cauda equina can cause permanent nerve damage or paralysis. The nerve damage can result in loss of bowel and bladder control as well as sexual dysfunction. This disorder is called cauda equina syndrome. Other complications include chronic pain. Cause[ edit ] Most authors favour degeneration of the intervertebral disc as the major cause of spinal disc herniation and cite trauma as a low cause.
Specifically, the nucleus becomes fibrous and stiff and less able to bear load.
The load is transferred to the anulus, which, if it fails to bear the increased load, can lead to the development of fissures. If the fissures reach the periphery of the anulus, the nuclear material can pass through as a disc herniation.
When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 17 psi lying down to over psi lifting with a rounded back. Herniation of the contents of the disc into the spinal canal often occurs when the anterior side stomach side of the disc is compressed while sitting or bending forward, and the contents nucleus pulposus get pressed against the tightly stretched and thinned membrane anulus fibrosus on the posterior side back side of the disc.
The combination of membrane thinning from stretching and increased internal pressure to psi results in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, which may produce intense and potentially disabling pain and other symptoms.
Probable candidate genes like type I collagen sp1 sitetype IX collagenvitamin D receptoraggrecanasporinMMP3interleukin-1and interleukin-6 polymorphisms have been implicated in disc degeneration.
A primary focus of surgery is to remove pressure or reduce mechanical compression on a neural element— either the spinal cordor a nerve root. But it is increasingly recognized that back pain, rather than being solely due to compression, may also be due to chemical inflammation.
The thoracic region accounts for only 0. Herniations usually occur posterolaterally, where the anulus fibrosus is relatively thin and is not reinforced by the posterior or anterior longitudinal ligament.
The rest of the spinal cord, however, is oriented differently, so a symptomatic posterolateral herniation between two vertebrae will actually impinge on the nerve exiting at the next intervertebral foramen down.
The nerves of the cervical plexus and brachial plexus can be affected. Nerve roots are numbered according to the vertebral body below them except the C8 nerve root. Lumbar disc herniation[ edit ] Herniated lumbar disc 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.
The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica. The femoral nerve can also be affected  and cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet or even a burning feeling in the hips and legs.
A hernia in the lumbar region often compresses the nerve root exiting at the level below the disk.Bulged Discs A bulged disc occurs as a result of an injury. The original damage often occurred years prior to the symptom of back pain arriving.
The problem with this injury is that discs are made of cartilage and cartilage more often than not, breaks down, as a result . Chiropractic treatment of sciatica is based on the philosophy that restricted spinal movement leads to pain and reduced function.
Anterolisthesis vs Spondylolisthesis. Spondylolisthesis is the general term for slippage of one vertebra on an adjacent vertebra. The slippage can either be anterolisthesis or retrolisthesis.
Radiculopathy is a diagnosis commonly made by physicians in primary care specialities, chiropractic, orthopedics, physiatry, and neurology. The diagnosis may be suggested by symptoms of pain, numbness, and weakness in a pattern consistent with the distribution of a particular nerve root.
The fasciablaster is literally rippling people’s fascia apart, causing damage to skin, hormonal problems, burst appendix, blood clots, miscarriage, and other serious, possibly permanent or fatal issues.
A cervicogenic headache starts in the cervical spine—your neck. Sometimes these headaches mimic migraine headache symptoms. Initially, pain may begin intermittently, spread to one side (unilateral) of the patient's head, and become almost continuous.