When a disc herniates, disc tissue between the vertebrae leaks out toward the nerve canal and can cause pain and/or neurological deficits.
The intervertebral discs are located between the vertebral bodies. They consist of a gel-like core with an elastic sheath of cartilage fibers. Degenerative wear and tear leads to a decrease in the elasticity of the intervertebral discs, they lose fluid and become brittle and cracked.
In the case of a herniated disc, the viscous material escapes from the disc nucleus (nucleus pulposus) and "squeezes" nerve structures in or outside the bony spinal canal. These pathological changes cause back or neck pain or radiate into the legs or arms at rest or under stress and can cause sensory disturbances and paralysis.
The intervertebral disc bulges out between the vertebral bodies, but the outermost shell is still intact.
The outermost sheath of the intervertebral disc is torn (annulus tear). This allows the tissue to escape, but it is still connected to the disc.
The disc tissue has leaked into the spinal canal and is no longer in contact with the disc.
An estimated 1 - 5% of all people suffer from low back pain in their lifetime, triggered by a herniated disc. Men are affected twice as often as women.
A herniated disc can be very painful to immobilizing. The pain often occurs suddenly in the back or legs and may also disappear on its own. Some patients suffer from the pain permanently, while others are affected in episodes.
In most cases, the pain and movement restrictions subside on their own within a few weeks. However, if the symptoms persist for more than 4-8 weeks, spontaneous recovery is rather unlikely. If the pain persists for longer, it is advisable to consult a specialist. In the consultation, the specialist addresses individual symptoms and selects the appropriate therapy option together with the patient.
In order for the pain to be treated in a targeted manner, the focus of treatment is on finding its cause. With the help of various examinations and clarifications, an exact diagnosis can be made in most cases:
- File study
- Medical history and physical examination
- Use of imaging techniques such as MRI, CT and X-ray
- Neurological assessment, electrophysiological studies such as SSEP or MEP if necessary.
The general desire for mobility, activity and a high quality of life in the long term has led to further development of conservative, but also surgical treatment methods. Therefore, after diagnosis, it makes sense to choose a treatment that is individually tailored to the patient.
A large proportion (approx. 70-80%) of those affected with a herniated disc can be treated conservatively, i.e. without surgical intervention. Thus, pain medication and/or CT-guided infiltrations, targeted physiotherapy and further measures such as chiropractic or osteopathy often lead to a significant improvement of the complaints.
In the case of a herniated disc, surgery is only necessary if the measures of conservative therapy do not achieve any success over a longer period of time or if further complaints such as paralysis and sensory disturbances occur.
The surgical procedure chosen for herniated discs is usually microsurgical decompression. This minimally invasive technique relieves pressure on the bruised nerves by freeing prolapsed disc tissue. In rarer cases, endoscopic procedures are used and performed.
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