What is a Herniated Disc?

By Moses Jacob, DC
Categories: , , , ,

Male back pain. African American with herniated disc

Herniated Disc Overview

The inter-vertebral disc is composed of cartilage tissue between two spinal vertebra. It serves as a cushion separating two bone. The outer strong fibers are called the annulus with a nucleus of gelatinous material in the center. Mechanically the discs function as the “shock absorbers” for the spine.

There are 23 discs in human spine, There are 23 discs in the human spine: 6 in the neck (cervical region), 12 in the middle back (thoracic region), and 5 in the lower back (lumbar region). In human’s formative years the disc due to a combination of fluid material and crossing outer ligament fibers, has a well defined shape. With the passage of time disc material begins a process of degeneration.

Disc Terminology (1)

  • Normal (excluding aging changes)
  • Congenital/developmental variants
  • Degenerative/traumatic lesion
  • Anular tear: Herniation Protrusion/extrusion

What is the Definition of a Herniated Disc?

  • Localized displacement of disc material beyond the normal margins of the intervertebral disc space.
  • Any displacement of disc tissue beyond the disc space.
  • The most common meaning for herniated disc refers to the central nuclear and other disc material which has extended beyond the normal space. Less significant herniation are termed bulge or protrusion.

More serious lesions are called extrusions. Anular tears, also properly called anular fissures, are separations between anular fibers, avulsion of fibers from their vertebral body insertions.

How is a Diagnosis of Herniated Disc Made?

Health care providers including chiropractor, osteopaths, and allopathic doctors, rely on the taking of a good history, which in combination with clinical exam tests including, straight leg raise, reflexes, sensory and motor tests and with findings on x-ray, CT scan, MRI and nerve conduction tests to provide the necessary positive findings to offer an appropriate diagnosis.

What are the Treatment Options for a Herniated Disc?

Patients should rely on conservative care as a first option. Conservative care includes instruction in proper body mechanics, education is standard exercises including , Flexion (See Williams type) , or extension (see McKenzie). Yoga has also been shown helpful for some class of patients. Treatment options should include spinal manipulation (SMT) by see chiropractor. SMT has been shown to be safe and effective. Other methods include distraction methods (see Cox or inversion devices). Over the counter medications may be helpful. Acupuncture is also effective and provides relief. Is some cases time is a good remedy. There are known and documented cases of herniated disc self resorption. Surgery is last resort medical procedure when all conservative care has proven ineffective or failed.

(1) Nomenclature and Classification of Lumbar Disc Pathology Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology by David F. Fardon, MD,* and Pierre C. Milette, MD†