The intervertebral disc is composed of two structures: in the interior, the nucleus pulposus, and in the periphery and containing the nucleus pulposus, the annulus fibrosus. Disc herniation occurs when the annulus fibrosus ruptures and the nucleus pulposus comes out.
In the specific case of lumbar disc herniation, the rupture of the annulus fibrosus usually occurs in its posterolateral portion, which is very close to the exit of the corresponding nerve root. Consequently, if the herniated volume is considerable, there will be radicular irritation with inflammation and significant pain in the form of either sciatica (most frequently), if the herniation is at L4-L5 or L5-S1, or cruralgia, if the herniation is at L2-L3 or L3-L4.
The causes that can give rise to a herniated disc are not well known, but it is known that it is usually associated with a weakness of the osteo-ligamentous system.
Symptoms of disc herniation
The most common symptom is radicular pain. If the herniation is cervical, cervicobrachialgia will occur, which consists of pain in the cervical region that extends to the upper limb. If the hernia is lumbar (the most frequent), the painful manifestation will be in the form of sciatica – posterior thigh and leg – or in the form of cruralgia – anterior thigh and leg.
Other symptoms may appear as weakness of different muscle groups, sensitivity disorders in the form of cramping or tingling and alteration of the bladder or rectal sphincters.
Treatment of disc herniation
It goes without saying that 80% of herniated discs cease to cause pain simply if the patient undergoes conservative treatment, and only 20% of them will require surgical treatment.
Currently, disc herniation surgery can be minimally invasive, and if done with surgical microscopy and thoroughness, the patient can be discharged within a few hours of surgery, as we have demonstrated in the Major Outpatient Surgery program that I set up at the Hospital Universitario La Paz almost two years ago.
Can disc herniation lead to other pathologies?
Neurosurgery specialists explain that a badly treated disc herniation can cause an overload of the adjacent disc spaces, which can lead to the appearance of new herniated or degenerated discs that would end up forming osteophytes or osteoarthritis and, eventually, canal stenosis, which, in turn, would again cause symptoms of radicular irritation and discomfort for the patient.