A herniated disc often results from trauma suffered in motor vehicle accidents and from work related injuries. The consequences of suffering from a herniated disc can result in loss of time from work, the need for medical treatment (possibly even including surgery), and the loss of enjoyment of one’s quality of life.

What is a Herniated Disc?

The spine runs from the back of the neck down to the lower back. It is composed of a series of connected bones called vertebrae that surround the spinal cord and protect it from damage. Nerves branch off the spinal cord and travel to the rest of the body, allowing for communication between the brain and the body. By sending a message down the spinal cord and out through the nerves the brain can make muscles move. The nerves also send monitoring information such as pain and temperature from the body back to the brain.

The vertebrae are connected by a disc and two small joints called "facet" joints. Each disc consists of strong connective tissues which hold one vertebra to the next. The disc is made of a tough outer layer called the "annulus fibrosus" and a gel-like center called the "nucleus pulposus. The center of the disc also contains water, helping the disc act as a cushion act as a cushion or shock absorber between the vertebrae. The disc and facet joints allow for movements of the vertebrae and therefore let you bend and rotate your neck and back. When a disc deteriorates or suffers trauma, the outer layer can tear, allowing displacement of the disc's center (called a herniated or ruptured disc) through a crack in the outer layer (the annulus), into the spinal canal (the space occupied by the nerves and spinal cord). The herniated disc can then press on the spinal nerves, often also resulting in inflammation. Depending on the location of the disc that is ruptured, this can cause pain, numbness, tingling or weakness in the neck, shoulders, arms, back, legs or feet.

Common Symptoms of a Herniated Disc

Common symptoms resulting from a herniated disc include:

• Prior to complete disc rupture with herniation, it is common to experience bouts of neck, shoulder, back, or leg pain. This pain comes from an injury to nerves. Damage to the sciatic nerve leading from the lower back down the leg is called sciatica.
• Once the disc ruptures, there can be an onset of sudden, severe, pain. For example, if the herniation involves the bottom two discs in the spinal column, the pain usually begins in the lower back. The bulging disc in this location exerts pressure on the sciatic nerve, and sharp pain may follow that nerve all the way down the leg and into the foot. Pressure on this nerve may also eventually cause numbness or a "pins and needles" sensation. Over time, the surrounding muscles can weaken and shrink in size.
• One may also experience numbness or weakness with a herniated disc. Again as an example, if the herniation is in the lower spinal cord, the numbness is most frequently reported to be in the calf, the sole of the foot or the big toe, and the weakness is often experienced as an inability to walk up the stairs normally, an inability to walk on the toes, an inability to lift the foot while walking (a "foot-drop"), or a weakness in flexing or extending the knee, foot, or leg.
• In certain circumstances, there may also be the onset of difficulty controlling urine (bladder incontinence), difficulty controlling bowel movements (bowel incontinence), or numbness in the perineal region (saddle region), usually noticed after wiping in the bathroom. These symptoms may indicate the presence of cauda equina syndrome, which can require immediate surgical attention.

Diagnosis of a Herniated Disc

X-rays of the low back area are obtained to search for unusual causes of pain, including tumors, infections, fractures, etc. CAT Scans and MRIs of the spinal cord area are used to identify the disc herniation and determine the degree of the degeneration. Your doctor may test for changes in the reflexes, sensation and strength caused by the herniated disc. A nerve test may also be ordered to determine whether there is ongoing nerve damage, whether the nerves are in a state of healing a past trauma, or whether there is another site of nerve compression.

Treatments for Disc Herniations

The initial treatment for a herniated disc is usually conservative, nonoperative treatment. One usually begins with resting the low back area, maintaining a comfortable posture and painless activity level for a few days to several weeks, to allow the spinal nerve inflammation to resolve. In addition, non-steroidal anti-inflammatory medication such as Motrin, Voltaren, Naprosyn, Lodine, Feldene, Clinoril, Tolectin, Dolobid, Advil or Nuprin may also be used. Other medication alternatives can include an epidural steroid injection utilizing a spinal needle with the guidance of x-rays to direct the medication to the exact level of the disc herniation.

Physical therapy may also be beneficial. The therapist can perform an in-depth evaluation, and use the information obtained from the evaluation, combined with a physician's diagnosis, to create an individualized treatment plan. The treatment plan may include the use of such modalities as traction, ultrasound, and electrical muscle stimulation, to relax the muscles which are in spasm and secondarily inflamed from the compressed spinal nerve. Pain medication and muscle relaxing medications may in combination with the physical therapy or other conservative, non-operative treatment to relieve pain while the spinal nerve root inflammation resolves and the body heals itself. The majority of disc herniations (approximately 90%) respond well to conservative treatment. In those cases in which conservative treatments are not successful and the pain is still severe or muscle weakness is increasing, surgery may be the next option.

Surgery may be in the form of a percutaneous discectomy if the disc herniation is small and not a completely extruded disc fragment. If the herniation is large, or is a free fragment, a microlaminotomy with disc excision may be necessary. A microlaminotomy requires one to two days of hospitalization after the surgery for the wound to heal and postoperative physical therapy to begin.

Legal Options

If you or someone you love have suffered a herniated disc in an accident due to someone else’s negligence or intentional acts, you should immediately contact a competent attorney. The attorney will work with the injured person to determine the legal options that may be available. These options can include workers’ compensation and the possibility of recovering directly from the person or persons responsible for the injury. Given that the cost in medical expenses and loss of income resulting from a herniated disc injury can rise into the hundreds of thousands and even millions of dollars, exploring legal remedies may make a substantial difference.