Intervertebral Disc Herniation: Etiology, Clinical Findings and Treatment

Intervertebral disc herniation, as one of the most common medical conditions affecting the spine, occurs when the nucleus pulpous (central portion) of the intervertebral disc bulges out beyond the outer fibrous ring. This prolapse results with nerve root compression. If such changes occur in the spine, the patient is forwarded to the appropriate specialist (physiatrist, neurologist or neurosurgeon). In 90% of the cases, the condition is present in the lumbar area of the spine, between the L4-L5 and L5-S1 segments.

Intervertebral disc herniation usually occurs in young, slender, and tall people due to improper bending or lifting. Another common cause of the condition is premature degenerative changes in the intervertebral discs in the lumbar area. Injury, inflammation and tumors are less common causes of disc herniation. During forward bending, the front portions of the vertebrae are brought closer to each other, while the opposite parts are stretched. Cross section of the disc in such position would resemble an acute-angled triangle. When additional pressure is caused in this position, a tear in the outer, fibrous ring will occur, which will cause prolapse of the inner, gel-like center. In most cases, the herniation causes pressure on the nerve root, but it may also press the spinal cord in some patients.

In the initial stages of the conditions, the evaluation includes a physical examination and meticulous assessment of the patient’s medical history. Intervertebral disc herniation causes a characteristic posture. By leaning on the side, the pressure and pain caused by the affected disc is reduced. Pain in the lumbar region, which radiates through the hip and the back of the thigh, is another symptom of the condition. Lack of tendon reflex and Achilles reflex is also a sign of a herniated intervertebral disc.

The patient feels increased pain during sudden movements caused by sneezing, laughing and coughing. Gradual or sudden leg lifting causes increased pain. Depending on the level of herniation, the patient may be unable to walk on their toes or heels. Reflex spasms of the paraspinal muscles are a defensive reaction that indicates intervertebral disc herniation.

The conventional treatment of intervertebral disc herniation can be conservative (drug therapy, physical therapy and exercise) or surgical. The conservative treatment is used in patients without complications or permanent neurological damage. When the patient experiences acute pain, he is advised to lie on the back on a hard, flat surface with the legs bent in the knees. This position alleviates the pressure caused by the herniated disc. Surgery is required in cases where the conservative treatment is inefficient and the condition is getting worse.