Overview
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. Unlike mechanical back pain, herniated disc pain is often burning or stinging, and may radiate into the lower extremity. Furthermore, in more severe cases, there can be associated with weakness or sensation changes. In the spine, a disc or a nucleus pulposus is localized between vertebral bodies. It supports the spine by acting as a shock-absorbing cushion. In some instances, a herniated disc injury can compress the nerve or the spinal cord that causes pain consistent with nerve compression or spinal cord dysfunction, also known as myelopathy. Herniated discs can be very painful. Unfortunately, there are limited effective conservative treatment modalities with significant effectiveness. Within a few weeks, most cases of painful disc herniation heal. In many instances, the herniation of the disc does not cause that patient any pain. Herniated discs are often seen on MRIs of asymptomatic patients. Imaging is not indicated in a patient with signs and symptoms of a stable herniated disc until six weeks of persistent symptoms. MRI is the imaging modality of choice. Most cases of herniated disc heal conservatively, but refractory cases may require interventional procedures or surgical repair. Epidural corticosteroid injections are effective pain relievers for disc herniation in the short term, while discectomy is more effective than conservative management until one year following surgery . Providers need to remain aware of treating the patient with a herniated disc and monitor for severe or rapidly progressing neurological changes; this would be an indication for urgent neurosurgical referral.
