As of: January 13, 2024 12:26 p.m
After a certain age, herniated discs are completely normal. There is hardly anyone over 40 whose intervertebral discs are not damaged. If symptoms occur, exercise is important and surgery can often be avoided.
The intervertebral discs are elastic shock absorbers between our vertebral bodies. There are 23, they distribute the pressure evenly across the entire spine. They consist of a soft gelatinous core surrounded by a fibrous ring. The elasticity of the intervertebral discs arises from the fact that the gelatinous mass fills with nutrient fluid like a sponge when the pressure is removed. The older we get, the more the intervertebral disc’s ability to bind fluid decreases.
Herniated disc: These are the symptoms
Many people do not notice a herniated disc at first; it is often an accidental finding. A herniated disc, also known as disc prolapse, can occur anywhere in the spine; by far the most commonly affected area (approx. 90 percent) is the lumbar spine (lumbar spine). This is where the mechanical stress on the spine is greatest. This is followed by the cervical spine and – rather rarely – the thoracic spine (BWS).
Symptoms in the lumbar spine area
The following symptoms are typical of a herniated disc in the lumbar spine area:
Severe stabbing pain in the back and/or leg as well as in the feet Tingling and numbness in the legs and feet Loss of strength in the legs Symptoms of paralysis in the legs Problems emptying the bladder and stool
VIDEO: Herniated disc: what to do? (5 mins)
Symptoms in the cervical and thoracic spine
The following symptoms are typical of a herniated disc in the cervical spine:
Stiff neck and neck pain (shoulder and neck pain) Radiating pain in the head, arm, hand and fingers Numbness or tingling in the hand or arm Weakness or paralysis of the arm muscles In the worst case, gait disorders and paralysis of the legs
If a disc herniates in the thoracic spine, the pain is often limited to the affected section of the spine. The discomfort radiates from the shoulders around the chest.
Herniated disc: the diagnosis
In most cases, a conversation and a physical examination are sufficient for a diagnosis. Only if the pain does not subside after weeks of intensive treatment does an image examination make sense. The imaging procedures include X-rays, magnetic resonance imaging (MRI) and computer tomography (CT). Diagnosing images too early carries the risk of doctors drawing incorrect conclusions from the images. They often show changes in the area of the intervertebral discs that are not responsible for the symptoms and can lead to unnecessary operations.
Causes of a herniated disc
When the load is relieved, the intervertebral discs absorb nutrient fluid and release it again when the load is placed on them. Some factors, which often work together, can disrupt nutrient exchange and cause the intervertebral discs to lose elasticity:
Heredity Stress Lack of exercise Poor posture Overexertion Incorrect strain Lack of exercise Weak core muscles Overweight Smoking
Treatment of a herniated disc: Surgery is usually not necessary
In around 90 percent of herniated discs, the symptoms disappear within six to twelve weeks. The body’s self-healing powers are the reason. The leaked tissue is broken down. The treatment measures depend primarily on the symptoms. Many studies have shown that conservative therapies have at least as good a success rate as surgery. Prompt treatment is important to prevent the risk of so-called chronification, the development of a pain memory. In addition, poor posture can occur in the long term. Therapy is advisable if those affected have pain and numbness.
With conservative treatment, it is important to mobilize those affected and get them out of the pain. This is followed by targeted muscle building to improve posture. Stabilizing the muscles ensures a stable spine. And: the better those affected can move, the better the nutrition of the intervertebral disc.
The building blocks of conservative treatment at a glance:
Pain therapy: Painkillers and anti-inflammatory drugs such as paracetamol or so-called non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac are used. Tensions are released and movement becomes easier again. During infiltration, an anesthetic and an anti-inflammatory drug such as cortisone are injected under X-ray control.
Physiotherapy and exercise program
In physiotherapy, those affected learn how to move in a way that is compatible with their backs in order to provide the best possible relief for their backs. Strengthening exercises are used to specifically build up the weakened back muscles, especially the deep muscles. Movement promotes the healing process, but rest is counterproductive.
Functional back training is considered one of the most effective measures for treating back pain. Experts recommend starting an exercise program and physiotherapy as soon as possible. This preserves strength and mobility. Once the body has reabsorbed the lost tissue, the back is usually fully resilient again. Now it’s important to keep moving through regular exercise.
Applications: Massages or heat or cold treatments can also be helpful. Acupuncture can also be a component in conservative treatment.
Intervertebral disc prolapse: when is surgery necessary?
Surgery is not necessary for most of those affected. It becomes absolutely necessary if the bulging disc causes permanent damage to adjacent nerves. Doctors name the following indicators:
Severe neurological deficits such as paralysis of the arms or legs, bladder or rectum can no longer be controlled Massive, uncontrollable pain that severely limits everyday life and has not improved despite conservative treatment
The prolapse can be removed microsurgically or endoscopically. The aim is to remove only the disturbing tissue as gently as possible in order to preserve the function of the remaining intervertebral disc tissue as well as possible. For almost all those affected, the operation can quickly relieve the severe pain because the pressure on the nerve is relieved. The hospital stay usually only lasts a few days. Those affected can usually get up again just a few hours after the operation and are quickly able to bear weight again.
When does an artificial disc make sense?
Under certain conditions, a defective disc can be replaced with an artificial disc. However, these intervertebral disc prostheses are only useful in very few cases, especially in younger patients with an isolated herniated disc in the cervical spine. The prerequisites for an intervertebral disc prosthesis are stable vertebral bones and intact vertebral joints. The prosthesis, which is modeled on a natural intervertebral disc, is intended to maintain the distance between the vertebrae and their normal mobility, thus alleviating pain.
A final treatment option is a fusion of the spine (spondylodesis). Vertebral bodies are screwed together. At this point the spine remains permanently immobile.
Disc surgery? Make a decision calmly
Before those affected decide to undergo surgery, they should consider the following factors:
Is there a clear diagnosis for surgery based on general guidelines? If you are unsure: Patients have the right to a second opinion. An operation should be carried out in a clinic that specializes in the treatment of intervertebral disc diseases. Because: The prospect of successful therapy is better with doctors with a lot of experience
Herniated disc: How to prevent it
In the long run, after a herniated disc, no rest will help, but regular training and exercise with the aim of strengthening the muscles and relieving the pressure on the intervertebral discs. Lack of exercise is poison for the intervertebral discs. Functional back training is not only useful for treatment, but also for prevention. Training for the deep muscles on the sides of the spine is important. But the lower abdominal muscles also need to be strengthened, as they are usually weaker than the back muscles. Balance provides more body stability and improves posture.
Since the metabolism of the intervertebral disc works through movement, walking or other endurance sports such as walking make sense. In addition, being overweight can increase the risk of a herniated disc.
Bulging disc: Difference from a herniated disc
If the fibrous ring of the intervertebral disc is pressed forward but does not tear, this is a bulging disc. Similar to a herniated disc, the bulge can cause severe pain, but usually goes away after a few weeks.
Expert on the topic:
Specialist in general surgery
St. George Back Center
Lohmühlenstr. 5
20099 Hamburg
Further information
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The painkiller ibuprofen has an analgesic, anti-inflammatory and antipyretic effect – but is not without risks. more
Paracetamol is a commonly used pain reliever and fever reliever. Overdose and long-term use can be dangerous. more