Herniated disc: definition, symptoms, diagnosis and treatment

By Cristiano Antonino On May 2, 2023

A herniated disc consists of the rupture of the fibrous ring of the intervertebral discs, resulting in the protrusion of the nucleus pulposus contained within them and consisting of gelatinous material

The protrusion of the nucleus causes compression of the adjacent nerve roots, causing severe pain.

Herniated discs can affect any part of the spinal column, but are most commonly observed at the level of the L4-L5 and L5-S1 intervertebral discs.

What is a herniated disc?

A herniated disc is a very painful condition that affects the spinal column, the main support of the human body.

The spinal column is made up of 33-34 vertebrae between which are the intervertebral discs, consisting of an outer wall called the fibrous ring, and an inner gelatinous part called the nucleus pulposus and consisting of 88% water.

The intervertebral discs play a fundamental role, functioning as cushions that absorb the weight of the spine and providing the flexibility needed to perform large movements.

A herniated disc is caused by the compression of adjacent nerve roots caused by the rupture and leakage of the nucleus pulposus, and is therefore commonly referred to as a disc prolapse.

What are herniated disc symptoms

The symptoms of a herniated disc vary depending on its location and severity.

The main symptom is extremely intense pain at the herniation site, which may be cervical, dorsal or lumbar.

The pain may then extend, depending on the case, from the cervical region up to the arms (cervicobrachialgia) or from the buttock, down the thigh to the foot (sciatalgia); tingling, numbness and muscle stiffness are other characteristic symptoms.

In the event of the occurrence of these symptoms, a general practitioner or specialist should be consulted for investigations.

Causes

The main cause of a herniated disc is damage to the intervertebral disc due to various factors, such as:

Disc wear, which occurs with age. Over time, the intervertebral discs lose elasticity and resistance, which predisposes not only to the occurrence of herniated discs but also to other bone diseases.
Heavy work, which includes lifting heavy weights or strenuous physical exertion, causes continuous damage to the intervertebral discs and thus an increased susceptibility to protrusion of the nucleus pulposus.
Trauma, which causes violent damage to the spinal column (e.g. traffic accidents).
Intense sports, such as lifting weights or activities involving excessive jerking and twisting, especially when not practised correctly.

Prevention

Preventing herniated discs is not easy, however, there are behaviours that can be adopted to reduce the likelihood of the disease occurring.

These include:

Adopt a healthy, active lifestyle and a healthy, balanced diet rich in fruit and vegetables, achieving good body weight control.
Exercise regularly and correctly, without ‘do-it-yourself’ training. You can also practise sport at home, as long as you are supervised by professionals who can advise you on the most useful exercises and give you the right instructions. Small traumas such as muscle tears can lead to herniated discs, so in these cases it is a good idea to seek medical advice.
Stretching is also a good habit, as are yoga classes, Pilates and sports activities that aim to increase flexibility and elasticity. In particular, it can be helpful to do exercises for lumbosacral and ischio-crural muscle flexibility.

How to diagnose a herniated disc

For the diagnosis, it is essential for the specialist to collect anamnestic information regarding the patient’s lifestyle, diet, regular sports activity and the possible presence of similar pathologies in his or her family.

The patient’s symptoms will then be investigated, analysing their location, severity and time of onset; it is also important to investigate any other concomitant manifestations.

In cases of high diagnostic suspicion, in-depth radiological tests such as MRI or CT scan are indicated.

The former allows an in-depth study of the spinal column, making it possible to rule out other causes of pain symptoms; CT scans, on the other hand, are intended for patients who cannot undergo MRI or for those in whom MRI has not provided conclusive results.

In cases where the diagnosis is particularly complex, electromyography may be indicated, i.e. an investigation that uses electrical impulses and evaluates nerve conduction.

Treatments for herniated discs

Choosing an effective treatment for herniated discs is not easy.

There are many factors that can influence the response to treatment, among them age, comorbidities, and the severity of the disease itself or the intensity of symptoms.

In severe cases, there may be an indication for surgery.

Therapies for herniated discs include the administration of:

pain-relieving drugs
myorelaxant drugs
corticosteroid drugs

Often these treatments are then accompanied by physiotherapy sessions, characterised by targeted and repeated exercises. Other practices include ultrasound and electrostimulation.

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