Anatomy & Function
The spine consists of a total of 24 vertebral bodies and can be divided into cervical, thoracic and lumbar spine. Between the vertebral bodies are the intervertebral discs (disci intervertebralis), which are composed of an outer fibrous ring (annulus fibrosus) and an inner nucleus (nucleus pulposus). The outer fibrous ring consists of fibrocartilage and connective tissue, while the inner nucleus consists largely of water. Together with the vertebral arches, the vertebral bodies form the vertebral canal (spinal canal), in which the spinal cord nerves (spinal nerves) run.
With regard to the function of the intervertebral discs, two main functions can be named.
On the one hand, they serve as "shock absorbers" of the spine and thus contribute to relieving the entire spine. Secondly, they form a kind of joint between the vertebral bodies and thus enable the mobility of the spine.
A herniated disc, also called disc prolapse, describes the leakage of disc tissue into the spinal canal. As a result, nerves in the spinal canal can become constricted or irritated. Herniated discs occur most frequently between the ages of 30 and 50.
Symptoms & Complaints
Signs of a herniated disc may include:
- Back pain
- Sensory disturbances,e.g.tingling, numbness
- Paralysis
- Disorders of bladder and bowel emptying
The severity of symptoms can vary greatly depending on the extent of the herniated disc: Some sufferers experience no symptoms, while others may require emergency care.
A herniated disc can make itself felt through sudden, stabbing back pain. In the majority of cases, an intervertebral disc in the lumbar spine is affected, as intervertebral discs in this area are subject to particularly high pressure. Accordingly, the pain occurs mainly in the lower back and can radiate to the buttocks, leg or even to the foot. In the much less frequently affected cervical spine, neck pain, shoulder pain and pain radiating into the arm can occur.
In order to recognize and treat an emergency in good time, warning signs (so-called "red flags") are described below, the occurrence of which should prompt medical assistance. These include signs of paralysis in which individual muscles can only be moved in a weakened manner or not at all. For example, the big toe or the entire foot can no longer be lifted in such a case. The sudden inability to empty the bladder or bowels, or a sudden onset of incontinence, also represent an emergency situation.
Causes
Causes of a herniated disc include:
- Age-related (degenerative)
- Accidental (traumatic)
Herniated discs occur most frequently in the context of wear and tear of the intervertebral discs. From the age of 20, the supply of nutrients to the intervertebral disc steadily decreases, so that small tears in the outer area of the disc can only heal insufficiently. Now, additional stresses can lead to a complete tear of the outer fibrous ring and thus to an escape of disc tissue into the spinal canal.
More rarely, accidents are responsible for herniated discs.
Diagnosis
As a first step on the way to diagnosis, our spine specialist. Priv.-Doz. Dr. Pestka will ask you about your complaints in a detailed interview. This includes, among other things, the temporal course, the exact localization and the strength of the complaints. In the course, a physical examination of the spine and a neurological examination will take place.
In addition, special tests exist that can detect nerve irritation (root elongation signs). Among other things, the Lasègue test should be mentioned here. The person to be examined lies on his/her back and the doctor lifts the stretched leg. If this results in shooting pain, this indicates irritation of the nerves.
Depending on the extent and localization of the damage, a decision is made on how to proceed. If one or more warning signs are present, a magnetic resonance imaging (MRI) should be performed. In an MRI image, the location of the protruding disc material can be precisely determined and the condition of the disc assessed. In this context, the importance of a conventional x-ray of the spine should also be pointed out. Since this is typically performed in the standing position, additional statements can be made about the stability and shape of the spine under load, in contrast to the MRI.
Treatment
The choice of therapy depends mainly on the cause and extent of the damage. Wear-related disc herniations in which no warning signs are present can be treated conservatively. In contrast, in the case of herniated discs caused by accidents, the presence of warning signs or a tendency to deteriorate, a surgical method should be recommended. Otherwise, there is a risk of long-term damage to nerves.
Our spine specialist Priv-Doz, Dr. Pestka will be happy to advise you further in this regard and clarify any open questions with you.
Conservative therapy:
The following conservative therapies are available:
- Drug therapy: analgesics
- Injection of analgesics near the nerve root (periradicular therapy).
- Heat therapy
- Physiotherapy
Drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain. If this does not provide sufficient pain relief, weakly or strongly acting opioids can also be used. To provide local relief of pain, a local anesthetic may be injected near the affected nerve root in particularly severe cases.
Heat applications and the start of physiotherapy, which helps to strengthen the trunk muscles, can also be helpful.
It is important for patients to know that despite pain, bed rest should not be observed, but everyday physical activity should be maintained. In addition, self-directed exercises, preferably under the guidance of physiotherapy, are essential.
Operation:
The method of choice is a minimally invasive nucleotomy. In this procedure, the protruded part of the disc is removed through a small incision in the back.
Everything at a glance:
- Operation time: maximum 60 min
- Anesthesia: General anesthesia
- Clinic stay: inpatient
- Fit for work: after 4-6 weeks
- Return to sports (RTS): after 3 months
Aftercare
Patients remain in the hospital for monitoring for about three to five days after the operation. Physiotherapy is started after the operation. In general, prolonged sitting or standing and lifting heavy loads should be avoided.
