Herniated Discs and Disc Degeneration

The spinal discs are sometimes referred to as the shock absorbers of our spine. They literally cushion the stress placed on our spine by providing a gap between the vertebrae. The disc consists of two parts. The center, referred to as the nucleus pulposis is comprised of a gelatinous matrix similar to jelly. The matrix is made of mostly water. The outer covering that keeps the nucleus intact is called the annulus fibrosis which is made of criss-crossing fibers. The disc itself consists of about 88% water, but as we age, the disc begins to lose water which flattens or thins the disc. This is known as disc degeneration. Disc degeneration also occurs more rapidly after disc injury such as an annular tear. As the disc thins, more stress is placed on the joints behind the disc. More severely, the narrowing actually reduces the size of the opening where the exiting nerve roots extend from the spinal canal. The reduction in the size of the "nerve hole" creates irritation and causes an inflammatory process to ensue. The result is a myriad of effects that include inflammation of the nerve, inflammation of the surrounding tissue, muscle spasm and pain. The most common mechanism of injury to a disc is a compression of the disc coupled with a shearing motion or twisting. When a disc is injured from overstress, like lifting a heavy object, the fibers of the annulus are torn which allow the nucleus to ooze from its center. This creates a bulging which can pinch the exiting spinal nerve or even the dural sac called the cauda equina. Depending on the severity of the herniation or bulging, a patient may experience a variety of symptoms including localized back pain, leg pain or burning, numbness, tingling, or weakness of the muscles of the legs. Some serious emergent conditions may require immediate medical care such as Cauda Equina Syndrome. Symptoms include loss of bowel or bladder control and numbness around the anal region. Other serious neurological symptoms include loss of balance, paralysis or foot drop.