26/12/2025
Herniated Spinal Disc
A herniated (or slipped) disc occurs when the soft center of a spinal disc, the nucleus pulposus, protrudes through a rip or crack in the tougher outer layer (annulus fibrosus). This herniation can irritate or compress adjacent spinal nerves, leading to pain and other symptoms.
Anatomy involved
Vertebrae:
Nucleus pulposus.
Annulus fibrosus.
What causes a disc herniation?
Age-related degeneration (disc dehydration and weakening).
Acute injury or heavy lifting with twisting.
Repetitive strain or prolonged poor posture.
Gradual wear-and-tear leading to a fissure in the annulus.
Common symptoms
Pain: Localized to the back or neck, often sharp or burning.
Radicular pain: Pain radiating along a nerve distribution (e.g. sciatica when lumbar discs compress the L5 or S1 nerve roots).
Numbness or tingling: Usually in the area supplied by affected nerve.
Weakness: In the muscles served by the compressed nerve.
Symptoms may worsen with activities such as sitting, bending, coughing, or sneezing.
Some individuals have no symptoms, or symptoms may improve with time.
Typical locations
Lumbar spine (lower back): Most common; symptoms often radiate down the leg (sciatica).
Cervical spine (neck): May cause neck pain, shoulder/arm pain, numbness, or weakness.
Thoracic spine: Less common; pain can be mid-back with sensory changes or weakness in the trunk.
Diagnosis
Clinical evaluation: History and physical examination focusing on neurological signs (strength, reflexes, sensation).
Imaging:
Conservative management (most cases):
- Rest and activity modification as symptoms allow.
- Physical therapy to improve core strength, flexibility, and posture.
- NSAIDs or a**lgesics for pain control.
- Short course of muscle relaxants or neuropathic agents (e.g., gabapentinoids) if nerve pain is significant.
- Epidural steroid injections may help reduce inflammation and pain in selected cases.
- Education on body mechanics and activity pacing.
- When to consider surgery:
- Persistent, severe leg or arm pain unresponsive to conservative treatment after 6тАУ12 weeks.
- Progressive weakness or difficulty with walking or hand function.
- Ca.
