SLIPPED SPINAL DISCS
Slipped Disc – Understanding Your Condition
A slipped disc is a common condition affecting mostly people aged 30-50, although it is not unheard of in people younger or older than those in that age range. The condition occurs when the outer layer of one of the intervertebral discs splits, allowing the inner layer to ooze out. This soft interior can leak into spaces occupied by nerve roots, and even the spinal cord itself, causing pressure and the painful symptoms you may be experiencing. For some people, symptoms come on gradually and are almost unnoticeable at first, slowly building in intensity until small daily tasks and even walking become difficult. For others, the pain and other symptoms may appear suddenly and severely, limiting their activities almost overnight.
The term “slipped disc” is quite misleading, since as described above, the affected spinal disc has not moved out of place. Further complicating the issue are the many other monikers used to describe this condition. All of the following terms refer to the same problem:
Slipped disc
Prolapsed disc
Ruptured disc
Herniated disc
Torn disc
Herniated nucleus pulposus (HNP)
These terms are often used interchangeably to describe the condition, and when you are diagnosed, your doctor may also mention an additional name: bulging disc. That is because in many cases, a slipped disc is simply the progression of an existing bulging disc, which occurs when a portion of a disc protrudes out of its normal parameters. When a bulging disc’s walls become too weak, or the pressure on it becomes too severe, the bulge ruptures, and the sufferer then has a slipped disc.
Interestingly, while slipped discs are relatively common, most cases go undiagnosed because they are asymptomatic. In those scenarios, the disc tissue never reaches a nerve root or the spinal cord or creates enough pressure to cause symptoms. Additionally, most cases heal themselves within about six weeks, so unless the person with an asymptomatic slipped disc undergoes diagnostic testing for another back issue, it’s unlikely that they’ll ever realize their disc has split.
Slipped Disc Anatomy
Slipped disc at L5-S1 of the Lumbar Spine
To truly understand what causes a slipped disc and why some people experience symptoms, but not others, it’s necessary to be familiar with the physical components of the spine that play a role in the condition. Knowing the way your condition developed and how the symptoms are being caused can help you work with your doctor to determine potential treatments.
The structures that can be involved with a slipped disc include:
Intervertebral discs – The main components affected in this condition, the spinal discs are cartilaginous structures that lie in between every vertebra in the spine except for the top two cervical vertebrae, the vertebrae in the sacrum, and those in the coccyx. They act in three capacities. First, they absorb shock to protect the vertebrae and other spinal components. Secondly, they act as a sort of joint to allow for slight movement of vertebrae. Thirdly, they help hold the vertebrae together and in position, giving the spine structure.
Annulus fibrosus – The outer layer of spinal discs is made up of multiple layers of fibrocartilage, which is a mix of cartilaginous tissue and white fibrous tissue. The first of the two provides elasticity, while the white fibrous tissue lends the disc flexibility and toughness. The durability and strength of this outer layer allow it to effectively hold in the nucleus pulposus and flex with the inner layer as it moves to redistribute pressure.
Nucleus pulposus – The core of an intervertebral disc, the nucleus pulposus provides the disc with its shock-absorbing quality by effectively redistributing pressure. As mentioned, it is a gel-like substance that is contained by the annulus fibrosus.
Vertebrae – there are 33 of these bones that make up the vertebral column, and they serve to protect the spinal cord. Each vertebra has two openings called foramina through which nerves pass to get from the spinal cord to the rest of the body.
Spinal cord – The main “highway” for the central nervous system and partner to the brain, the spinal cord is responsible for connecting the brain and peripheral nerves by transmitting signals to and from the brain and the rest of the body. It is involved in transmitting motor and sensory information, as well as coordinating reflexes.
Nerves and nerve roots –If the spinal cord is the central nervous system’s superhighway, then the nerves are the side roads. Thirty-one pairs of nerves extend from the left and right of the spinal cord and branch out to various parts of the body, bringing and sending data to and from the spinal cord. The bases of the nerves are called the nerve roots, which is the section that runs through the foramina and can be compressed by a slipped disc.
Causes and Risk Factors of a Slipped Disc
Each person has different factors that play into the development of a slipped disc, and only a doctor can provide a diagnosis. However, there are several common causes, including:
Aging – As your body gets older, your spinal discs lose water content and becoming more brittle, making them more susceptible to breakage.
Sudden trauma – Although rarer than the other potential causes of a slipped disc, sudden trauma like that from a car accident, severe fall, sports injury, or another event, can stress the disc so much that it tears. This is particularly true if aging or other factors already weaken it.
Extra wear and tear –Sports, a demanding job, or other regular activities that require repetitive motion or put a lot of stress on the back, can break down spinal discs faster and lead them to rupture.
Several issues may have contributed to the development of the diagnosed cause of your slipped disc. Some of the risk factors include:
Previous injuries - These can cause peripheral and concentric annular tears, which occur in the outer and middle layers of the annulus fibrosus, respectively. While these tears don’t create a complete breach of the annulus fibrosus, they can weaken the structure and leave it vulnerable to more severe ruptures in the future.
Obesity – Carrying excess body weight means that your spinal discs have to bear a heavier load, and the excess pressure can slowly cause the breakdown of the annulus fibrosus.
Smoking – Chemicals in cigarettes can have a significant harmful effect on your body, including your spinal discs. These substances are believed to hasten the deterioration of the discs and can contribute to a slipped disc.
Physically strenuous jobs – Work that requires heavy and repetitive lifting, twisting, and bending can stress the spinal discs and cause them to break down faster, as well as make them more susceptible to tears. But, sedentary jobs, like those that require sitting at a desk all day, can also contribute to a slipped disc. Any work that requires you to stand or sit in the same position for an extended period can hurt your spinal discs.
Family history – Just as some people are taller or shorter than others, you may be more predisposed to developing a slipped disc thanks to the genes passed down by your parents and grandparents. This could be due to congenitally thinner discs or any number of factors.
Symptoms of a Slipped Disc
As previously mentioned, a slipped disc can be asymptomatic. The condition only causes problems when the nucleus pulposus spills out and pushes on a nearby nerve root or the spinal cord. This pressure can inhibit the nerve tissue from effectively transmitting electrical impulses to and from the brain, which inhibits motor, sensory, and reflex function and causes symptoms including:
Pain
Pins and needles or a tingling sensation
Numbness
Weakness
Muscle spasms
Loss of full reflex function
These symptoms occur in the region of your body that is served by the affected nerve tissue. Slipped discs are organized into one of three categories:
Cervical (vertebrae C1-C7) – Symptoms are felt in the head, neck, shoulders, arms, hands, and upper back
Thoracic (vertebrae T1-T12) – Symptoms are thought in the middle back, chest, and abdomen
Lumbar (vertebrae L1-L5) – Symptoms are felt in the lower back, buttocks, thighs, calves, and feet
In addition to varying in their location, symptoms can also be experienced in different combinations and at different intensities. One person may experience pain and weakness, while another suffers from muscle spasms, loss of reflexes, and numbness. For some people, they come on suddenly and severely, while for others, it is a gradual process. Some people’s symptoms never cause more than minor discomfort and then disappear as their discs heal, while others must contend with daily, life-altering pain.
Slipped Disc Procedures
You may have already attempted several conservative, nonsurgical treatments that your doctor suggested to help find relief from your slipped disc. One of the best diagnostic tests to evaluate a slipped disc is vertebral motion analysis. But if you’ve failed to find relief through any of these treatments after several weeks or months, surgery may become an option.