How painful is a herniated disc?

What is a herniated disc?

Spinal discs have a soft jelly-like center and a tough outer layer. Spinal discs act like shock absorbers between the vertebrae, or bones, of your spine. Disc herniation happens when the soft center of a disc ruptures through a weak area in the tough outer wall. A herniated disc is sometimes referred to as a ruptured, torn, or slipped disc.

Disc herniations can happen in any area of the spine and may not cause any symptoms. If the protruding disc presses on a spinal nerve, it can send pain signals from any area of the body, depending on which spinal nerve has been affected. The most common areas of the spine for disc herniations are the neck (cervical) and lower back (lumbar). The symptoms are similar, but affect different areas of the body.

Pain from a herniated disc can be chronic or can occur in intermittent episodes of intense pain.  It can cause pain in the neck, back, or legs. Pain in the neck region, called the cervical spine, is addressed differently than pain occurring in the lower back and/or legs.

What does a herniated disc feel like?

You can’t feel a herniated disc on the outside of your back or neck. It is diagnosed with imaging, such as an X-ray or CT scan. A herniated disc also may not cause you to have any symptoms so you could never know you have one.

If a herniated disc in your lower back or lumbar spine causes symptoms, you will feel pain in your lower back and/or legs, and possibly down into your feet. If the herniated disc is in your neck, you will feel pain in your neck and/or your arms,  and possibly your hands.

What causes a herniated disc?

Most disc ruptures will occur in people in their mid-30s to mid-50s, when the disc is still a gelatin-like substance. Oddly enough, most disc herniations will occur in the morning. The causes of this phenomenon are not entirely known, but are probably due to the physiology of the spine and the changes in the water content of the disc that occur throughout the day.

Disc herniation often occurs due to an injury or improper lifting. When it occurs in older people, it is often the result of aging that causes the discs to dry out and become harder, a condition known as degenerative disc disease. When this occurs, the outer wall of the disc may weaken, making a rupture more likely.

How is a herniated disc fixed?

In most cases, the pain from a herniated disc will go away within 4 to 6 weeks with some home care, including:

• Ice. Cold packs or ice applied to the area may reduce inflammation and relieve pain.
• Physical therapy. Your provider may suggest physical therapy, possibly along with pain-relieving steroid injections so that exercises can be done with minimal discomfort.
• Pain medications. Over-the-counter pain relievers, such as acetaminophen (Tylenol), and non-steroidal anti-inflammatory medicines, such as ibuprofen or aspirin, may help relieve chronic pain caused by a herniated disc. Prescription pain relievers may be necessary during episodes of extreme pain but are not recommended for long-term relief.

If these measures don’t work or your pain is intense, we may refer to our pain management experts for steroid injections.

When will I need surgery for my herniated disc?

Very few people with herniated discs actually require surgery. At Neurosurgery One, our spine surgeons are conservative and will recommend surgery for a herniated disc only in patients experiencing pain that is not relieved by non-surgical treatments. We typically recommend that patients with degenerative disc disease try conservative treatments for six weeks before considering surgery. However, if the herniated disc is causing leg pain and/or a loss of bowel or bladder function, your spine surgeon recommend surgery sooner.

Neurosurgery One physicians may also recommend surgery if an imaging study shows that a fragment of disc is lodged in the spinal canal and pressing on a nerve or if you are having difficulty performing basic daily activities, such as standing or walking.

A herniated disc is usually treated surgically with a procedure called a discectomy. Discectomy surgery for a herniated disc removes the damaged disc to relieve pressure on the nerves that are causing pain. Surgery for a cervical disc herniation may combines a discectomy and spine fusion in a procedure call anterior cervical discectomy and fusion. ACDF, as the procedure is often called, is the most common surgery for neck pain.

Our neurosurgeons perform minimally invasive discectomy whenever possible. This minimally invasive spine surgery is called a microdiscectomy. We use special instruments to perform the procedure through small incisions. Patients who receive microdiscectomy typically have less pain and quicker recovery times. Neurosurgery One spine surgeons offer three types of microdiscectomy:

• Open microdiscectomy is sometimes called “mini open” discectomy. It is similar to a traditional discectomy, but the spine surgeon performs the procedure through a very small incision.
• Tube, or tubular, microdiscectomy uses a series of small expanding tubes to open or dilate the surgical area so the surgeon can get the proper view. The spine surgeon then uses special surgical instruments to remove part of the affected disc.
• Endoscopic microdiscectomy, also called microendoscopic discectomy, involves inserting an endoscope with a tiny video camera through a tube into a small incision. The spine surgeon then uses small instruments to remove the disc.

Spine surgery to relieve pain from a herniated disc tends to have high success rates. Between 78-85% of patients who have a discectomy for a lumbar disc herniation reported good or excellent results six years after their surgeries. Between 85%-95% of patients who had an ACDF report positive results.