Herniated Disc
(Disc Herniation of the Spine)
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Melissa Conrad Stöppler, MD
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Medical Author: Medical Author: William C. Shiel Jr., MD, FACP, FACR
The discs of the spine are located
between the vertebrae (bony building blocks of the spine).
The disc is designed somewhat like a jelly donut being composed
of an inner gelatin-like core (the nucleus pulposus) surrounded
by a firm outer ring (the annulus fibrosus).
When the disc structure wears, because of processes
such as aging or trauma, it becomes weakened and susceptible to
injury. In this condition, stresses on the spine can cause the
inner core to protrude outward through the boundary of the disc's
outer ring. The is referred to as herniation of the disc.
Disc herniation can directly press upon the spinal
cord and/or adjacent nerve tissues resulting in pain which radiates
outward from the spine in the distribution of the affected nerve.
When the disc herniation is in the spine of the lower back, it
can cause a radiating pain down the legs, commonly referred to
as sciatica.
A majority of patients with sciatica from disc herniation
have resolution of their pain with various conservative measures,
including antiinflammatory and muscle-relaxant medications, exercises,
physical therapy, and time. However, some 10%-15% of affected
patients require surgical procedures to relieve the pain.
How are the spine and its discs designed?
The vertebrae are the bony building
blocks of the spine. Between each of the largest parts (bodies) of the vertebrae
are the discs. Ligaments are situated around the spine and discs. The spine has
seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back
(thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In
addition, in the mid-buttock, beneath the fifth lumbar vertebra, is the sacrum,
followed by the tailbone (coccyx).
The bony spine is designed so that vertebrae
"stacked" together can provide a movable support structure while also protecting
the spinal cord (nervous tissue that extends down the spinal column from the
brain) from injury. Each vertebra has a spinous process, which is a bony
prominence behind the spinal cord that shields the cord's nerve tissue. The
vertebrae also have a strong bony "body" in front of the spinal cord to provide
a platform suitable for weight-bearing.
The discs are pads that serve as
"cushions" between the vertebral bodies that serve to minimize the impact of
movement on the spinal column. Each disc is designed like a jelly donut with a
central softer component (nucleus pulposus). Ligaments are strong fibrous soft
tissues that firmly attach bones to bones. Ligaments attach each of the
vertebrae and surround each of the discs. When ligaments are injured as the disc
degenerates, localized pain in the area affected can result.
What is a herniated disc? What causes it?
As described above, each disc of the spine is
designed much like a jelly donut. As the disc degenerates from age or injury,
the softer central portion can rupture (herniate) through the surrounding outer
ring (annulus fibrosus). This abnormal rupture of the central portion of the
disc is referred to as a disc herniation.
The most common location for a
herniated disc to occur is in the disc at the level between the fourth and fifth
lumber vertebrae in the low back. This area is constantly absorbing the impact
of bearing the weight of the upper body. This is especially important when we
are standing or sitting. The lower back is also critically involved in our
body's movements throughout the day, as we twist the torso in rotating side to
side and as we hinge the back in flexion and extension while bending or lifting.
Picture of herniated disc between L4 and L5
Cross-section picture of herniated disc between L4 and L5
Picture of stapled incision post-surgery
Next: What are symptoms of a herniated disc? »
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