A disc herniation is a common spinal condition occurring when one of the cushion-like discs between your vertebrae experiences a structural change. These discs serve as shock absorbers and allow spinal flexibility. When a disc herniates, it can lead to discomfort and affect daily activities.
What is a Disc Herniation?
The spine is composed of vertebrae, separated by intervertebral discs. Each disc has two main parts: a tough, fibrous outer ring (annulus fibrosus) and a soft, gel-like inner core (nucleus pulposus). A disc herniation happens when the inner nucleus pulposus pushes through a tear or rupture in the outer annulus fibrosus. This can occur due to natural aging and degeneration, where the disc loses water content and elasticity, or from trauma, strain, or repetitive movements. The displaced disc material can then press on nearby spinal nerves or the spinal cord, potentially leading to various symptoms.
Understanding Disc Herniation Size
Disc herniations are measured in millimeters using Magnetic Resonance Imaging (MRI), which provides detailed soft tissue images. While a 7mm disc herniation is often considered significant, especially in the lumbar (lower back) spine, where some classifications consider 7 millimeters or larger as severe, its impact is not solely determined by size. Some classifications consider herniations less than 5mm as small, 5-10mm as moderate, and greater than 10mm as large. Other perspectives classify anything over 3mm as large. The perceived “largeness” of a herniation is relative and does not always correlate directly with symptom severity.
Beyond Size: Factors Influencing Symptom Severity
The impact of a disc herniation extends beyond its measured size. A key factor is the herniation’s location along the spine, whether in the neck (cervical), mid-back (thoracic), or lower back (lumbar) regions. Most herniations occur in the lower back or neck. The specific orientation, such as central or posterolateral, also plays a role, as a posterolateral herniation is more likely to compress a nerve root. Direct compression on a spinal nerve or the spinal cord by the herniated material is a major determinant of symptoms. Even a smaller herniation can cause considerable pain if it directly impinges on a nerve, while a larger one might cause no symptoms if it is not pressing on nerve structures. The body’s inflammatory response around the herniation can also contribute to pain, even without direct nerve compression. Symptoms commonly include localized pain, radiating pain (like sciatica in the leg or pain down the arm), numbness, tingling, or muscle weakness. Diagnosis often involves a physical examination to assess pain, reflexes, sensation, and muscle strength, followed by an MRI for confirmation.
Treatment Approaches
Treatment for disc herniations includes conservative (non-surgical) and surgical approaches. Most cases resolve with conservative management. Conservative treatments often include rest, avoiding aggravating activities, and pain medication like over-the-counter anti-inflammatory drugs. Physical therapy is also recommended to reduce nerve pressure, improve strength, flexibility, mobility, and posture. Epidural steroid injections, delivering anti-inflammatory medication directly to the affected area, may be considered if oral medications are insufficient. Surgery is considered when conservative treatments fail after several weeks or months, or for severe symptoms like progressive muscle weakness, loss of bladder or bowel control, or significant neurological deficits. Common surgical procedures include microdiscectomy, a minimally invasive procedure removing a small portion of herniated disc material pressing on the nerve. Other options include discectomy, which removes the damaged disc part, or spinal fusion, which stabilizes the spine by joining vertebrae. Surgery is generally a last resort, as many patients find relief through less invasive methods.