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Herniated Disc Pressing on Nerves: A Common Condition That’s Treatable and Less Scary Than You Think

A herniated disc pressing on nerves is a common condition in people with lower back pain radiating down the legs. This occurs because the spine in this area carries a lot of weight and has a wider range of motion compared to other parts of the spine. As a result, the intervertebral disc may bulge or rupture and press on the nerves. Symptoms include lower back pain at the waist and hip, often radiating down one leg. There may also be numbness or weakness in the leg or foot.

This condition is commonly found in individuals between the ages of 30 and 50. Risk factors include heavy lifting, being overweight, sudden twisting or bending movements, and more.

Understanding the Intervertebral Disc: What It Is and Its Role in the Body

The human spine consists of vertebrae with intervertebral discs positioned between each vertebra. The function of the intervertebral disc is to bear the weight of the body, acting as a cushion between the vertebrae, enabling flexibility and movement.

Although it’s called an “intervertebral disc,” the structure is primarily made up of water, collagen, and other components like proteins. Inside the disc, there are two main parts:

1. Nucleus pulposus

The nucleus pulposus is the central core of the disc, composed of water (around 80%) and collagen. It absorbs shock and helps distribute the weight transmitted to the spine during body movements.

2. Annulus fibrosus 

The annulus fibrosus is the tough outer layer that encases the nucleus pulposus, preventing it from bulging out. It provides stability to the vertebral joints, allowing them to withstand twisting, bending, and other movements.

One unique aspect of the intervertebral disc is that it does not have direct blood supply to exchange nutrients, oxygen, and waste products. Instead, it relies on the pressure from surrounding vertebrae to facilitate nutrient exchange. This lack of blood flow contributes to the poor self-repair process of the disc, making it prone to degeneration over time.

Causes of Herniated Disc Pressing on Nerves

As mentioned earlier, the intervertebral discs play a crucial role in supporting and distributing the weight of the spine. The main risk factors for a herniated disc are excessive weight and abrupt or intense movements, which increase the likelihood of disc rupture. These factors include:

1. Excess Body Weight

Extra weight puts additional pressure on the spine, leading to greater stress on the intervertebral discs.

2. Improper Use and Accidents

Movements like bending backward, lifting heavy objects, or falling can place excessive pressure on the disc, potentially causing it to rupture.

3. Prolonged Sitting in Incorrect Postures

This is common in the working population, especially for those who sit for long hours, particularly in the lower back area, which bears the brunt of the weight.

4. Coughing or Sneezing Forcefully

These actions can suddenly increase pressure on the intervertebral disc, potentially causing a rupture if the disc’s outer layer is already weakened.

5. Smoke heavily

Cigarettes can cause premature degeneration of the spinal discs and increase the likelihood of disc herniation.

Types of Herniated Disc Pressing on Nerves

There are three main types of herniated discs:

1.Protrusion
The nucleus pulposus pushes out without causing a rupture in the outer layer of the disc.

2.Extrusion
The outer layer tears, and the nucleus pulposus bulges out, but it remains connected to the inside of the disc.

3.Sequestration
The outer layer tears, and the nucleus pulposus breaks free from the disc, becoming an independent fragment.

In the initial stages, pain can be intense due to two factors: nerve compression and inflammation caused by the ruptured disc. Around 80% of patients experience improvement in 4-6 weeks of treatment. However, some may still experience pain due to significant nerve compression, which might require surgery.

Why Does Pain Radiate Down Only One Leg?

As seen in the diagram, the bulging disc usually presses to one side of the spine rather than directly down the middle. This region houses nerves that can be compressed, leading to pain or numbness down one leg.

Diagnosing a Herniated Disc Pressing on Nerves

Initially, doctors will take a medical history and perform a physical examination to diagnose the condition. In most cases, this is sufficient for an initial diagnosis.

For more clarity, doctors will typically use an MRI (Magnetic Resonance Imaging) to confirm the diagnosis. MRI scans provide a clear view of the disc structure and the nerves, helping determine the location and severity of the compression, which aids in planning the appropriate treatment.

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Treatment Options for Herniated Disc Pressing on Nerves

1. Medication

Treatment often begins with medications such as pain relievers, anti-inflammatory drugs, muscle relaxants, or nerve pain medication. In some cases, an epidural steroid injection (a steroid injection near the affected nerve) may be administered using X-ray guidance to reduce pain and inflammation.

2. Non-Medication Treatment Physical Therapy

Physical Therapy

Physical therapy techniques like massage, ultrasound, laser therapy, and shockwave therapy help relax muscles and reduce pain. Additionally, stretching and strengthening exercises can improve muscle function around the spine.

Behavioral Changes

Doctors will analyze the patient’s behavior to identify any improper postures or movements that may be exacerbating the condition. Lifestyle adjustments are key to preventing future episodes.

3. Surgical Treatment

Surgery is typically recommended for patients whose pain persists despite conservative treatments. Surgical options for a herniated disc include:

1. Open Discectomy
An open surgery where the affected disc is removed via a larger incision (7-8 cm wide).

2. Microscopic Discectomy
A minimally invasive procedure using a microscope for clearer visualization of the nerves, reducing the size of the incision to 2-3 cm.

3. Endoscope (Endoscopic discectomy) 
A modern, minimally invasive technique where a small 8-mm incision is made, and an endoscope is used to remove the herniated disc.

These advances in surgical methods not only reduce the size of the incision but also minimize muscle and tissue damage, reduce blood loss, and promote faster recovery.

Conclusion

A herniated disc pressing on nerves is often a result of lifestyle habits and improper body mechanics. The best prevention is to adopt proper posture and movement patterns starting today. Small adjustments in daily activities can significantly ease the burden on your spine.

The MRI image shows a Herniated disc.

The image shows a spinal disc that has been surgically removed using an endoscope, with the incision size being less than 8 millimeters.

 

Q&A

Q: How long is the recovery time after surgery for a herniated disc pressing on nerves?

After surgery, patients usually experience immediate relief from leg pain, while numbness or weakness improves gradually. Within two weeks, patients can resume light activities such as sitting, driving, and walking short distances. Full recovery and return to regular work and exercise usually take 6-8 weeks.

Q: Can a herniated disc press on nerves return after surgery?

Studies show a recurrence rate of 10-15% after surgery. Risk factors for recurrence include improper posture, lifting heavy objects, smoking, and being overweight. Avoiding these behaviors can reduce the likelihood of recurrence.

Q: Why does poor posture, like slouching or bending while lifting, damage the intervertebral disc?

The spine carries the body’s weight constantly. If daily activities are done with improper posture, the spine experiences additional strain, leading to back pain. Research shows that when standing, the spine carries 100% of the weight, but in a seated position, it can bear 140-185% more. Lifting while seated can increase this pressure by up to 275%, causing strain on the intervertebral discs. Therefore, the correct posture to help reduce the load on the spine is to stand, walk, and sit with your back aligned in a straight position. Avoid lifting heavy objects unnecessarily to reduce the pressure on your spinal discs.

 

Rewritten by Asst. Clinical Prof. Warayos Trathitephun, MD.

Mon, 27 Jan 2025
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หมอนรองกระดูกเคลื่อน
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