Anatomy

The intervertebral disc is a fibro-cartilaginous cushion that acts as a means of union and
shock absorber between the vertebrae. It is composed of a compressible and mobile
gelatinous nucleus (nucleus pulposus) in the center (in pink on the diagram below),
surrounded by a fibrous ring on the periphery (in blue on the diagram below). The
progressive wear of the disc over time is a natural process, more or less early depending on
the individual, and depending on the mechanical stresses to which their spine is subjected.
This wear leads to cracking of the fibrous ring, and dehydration of the gelatinous core, which
gradually becomes dry and friable. A herniated disc is an issue of disc material, usually a
more or less voluminous part of the nucleus, in the vertebral canal, through a crack in the
peripheral ring. This eruption of disc material in the canal can lead to a conflict with the
nerves (spinal nerve roots) or the spinal cord located there. Compression of the nerves or
the marrow can cause pain, motor disorders, sensory disorders.
From an anatomical point of view, a herniated disc is defined according to 2 planes: a
horizontal (or axial) plane, which determines its position in the vertebral canal, and a vertical
(or sagittal) plane which determines its more or less excluded character. relative to the disc.

• The axial plane (horizontal plane passing through the disc) makes it possible to define 2
main types of herniated discs: intra-canal hernias, that is to say located inside the vertebral
canal, and extra-canal hernias or foraminales, that is to say located in the inter-vertebral
foramen or conjugation hole;
• The sagittal plane (vertical plane in profile) makes it possible to determine whether the
herniation is excluded from the disc or if it is still attached to its nucleus, and to determine
its possible migration upwards or downwards.

Epidemiology

In 90% of cases, herniated discs occur in the lumbar vertebrae and the symptoms concern
the lower back or a leg. It's lumbago and sciatic pain. In 8% of cases, the herniated disc
occurs in the cervical vertebrae and causes pain in one shoulder and one arm.

Some people are more at risk of suffering from a herniated disc:

• People between 30 and 55 years old. After age 55, the discs harden and are less prone to
rupture (but they are less flexible and the spine stiffens).
• Men, who have a higher risk of herniated disc than women.
• People whose professional activity exposes them to repeated efforts on the spine (carrying
loads, work requiring frequent bending, etc.) or those who spend hours driving (commercial,
truck drivers, etc.) .
• Athletes whose discs are subjected to intense and repeated pressure, sometimes
asymmetrically.
• Sedentary people whose back and abdominal muscles are not strong enough.
• Tall people or those with poor posture (hunched back).
•Pregnant women.
• People who have a familial predisposition.
• Obese people.
•Smokers.
Etiology

By losing water due to aging or disease, the discs lose height, which brings the vertebrae
closer together. The passage of the nerves in the spinal column then becomes narrower.
When this happens, the discs no longer absorb shock as well, especially when walking,
running or jumping.

Natural wear and tear, poor posture and incorrect movements can also weaken the disc,
causing it to degenerate.

A herniated disc can also occur as a result of a sudden movement of the back in poor
posture.

The disc thus weakened can let out the nucleus and cause a herniated disc.

Symptomatology

Compression of the disc on the nerve roots is the cause of different symptoms: sciatica when
it comes to the lumbar root and cervico-brachialgia, which is rarer, when the hernia is
cervical.

In addition to these two well-known symptoms of herniated disc, many others exist (non-
exhaustive list):

- Pain in the limbs. The route of the pain depends on the root compressed by the hernia;

- Sensation of pins and needles (paresthesia), disturbance of sensitivity (dysesthesia) which

may lead to complete loss of sensitivity (anaesthesia). The area affected depends on the
affected root;

- A partial or complete loss of muscle strength is also possible;

- Sphincter disorders are rare but possible in certain herniated discs;

The pressure of the herniated disc on the root is most often manifested by pain.
Prevention of herniated disc

It is not always possible to prevent a herniated disc, but there are ways to reduce the risk of
developing one:

- Do physical exercise
- Muscle strengthening and muscle stretching
- Maintaining a healthy weight
- Maintaining good posture
- Use of proper lifting techniques

Regular physical activity is an effective method to reduce the risk of herniated disc. Aerobic
activities as well as specific muscle strengthening and stretching exercises can be helpful.

Aerobic activities, such as swimming or walking, improve general well-being and strengthen
muscle tone.

Diagnosis

Diagnosis of a herniated disc typically involves a medical history review, physical

examination, and imaging tests such as X-rays, MRI, or CT scans. Treatment options for a
herniated disc may include non-surgical methods such as physical therapy, pain medication,
and hot or cold therapy, or surgical methods such as microdiscectomy or spinal fusion,
depending on the severity of the condition and the patient's overall health.

It's important to see a doctor if you suspect you may have a herniated disc, as prompt
treatment can help alleviate your symptoms and prevent further damage to your spinal
column. If you have persistent pain or numbness in your back, legs, or arms, or if you have
trouble moving or controlling your limbs, you should seek medical attention right away.

Non-surgical treatment

Applying cold (such as ice packs) or heat (such as a hot water bottle) or taking over-the-
counter painkillers (such as paracetamol and nonsteroidal anti-inflammatory drugs [NSAIDs])
can help ease the pain. If symptoms are not relieved with painkillers, doctors may prescribe
corticosteroids by mouth or by injection into the epidural space (between the spine and the
outer layer of tissue covering the spinal cord). However, whether these corticosteroid
injections are beneficial is controversial.
It is recommended to sleep in a comfortable position and on a medium firm mattress. People
who sleep on their backs can place a cushion under their knees. People who sleep on their
side can use a pillow to keep their head in a neutral position (not leaning towards the bed or
the ceiling). They should place another pillow between their knees and bend their hips and
knees slightly if this relieves back pain.
When pain subsides, physical therapy sessions and home exercises can improve posture and
strengthen back muscles, reducing spinal movements that further irritate or compress the
nerve root. (See also Prevention.)
Surgical treatment

If a herniated disc causes persistent or chronic sciatica, weakness, loss of feeling or control
of the bladder and bowels (cauda equina syndrome), surgical removal of the protruding part
of the disc (discectomy) and, in some cases, part of the vertebra (lumbar laminectomy) may
be necessary. General anesthesia is usually required. Hospitalization usually lasts one to two
days. Often, microsurgical techniques, with a small incision and regional spinal anesthesia
(which numbs only a specific part of the body), can be used to remove the herniated portion
of the disc. There is usually no need to be hospitalized for this procedure. After the
procedure, regardless of the technique used, the vast majority of people can resume all their
activities in 6 weeks to 3 months. Surgery tends to lead to faster recovery than non-surgical
treatment. However, after about a year or two, people treated with or without surgery show
about the same degree of recovery.

Rehabilitation

Regarding lumbar hernia in particular, physiotherapy is the best solution to reduce pain,
restore movement of the spine and repair the dysfunctions caused by the pathology.
First, the physiotherapist will reduce the pain by using:

The unloading posture

Manual techniques: pumping, traction, etc.
To therapies such as laser, tecartherapy, etc.
Then, the goal is to restore the posture of the spine by performing daily exercises, acquiring
certain habits and avoiding fatigue.
Finally, the last step is to regain trunk functionality; the patient will follow a rehabilitation
plan prescribed by the physiotherapist in order to stabilize the spine and strengthen the
back muscles.

In order to prevent such pathologies, it is essential to avoid keeping a bent position of the
neck as when leaning on our mobile to send a text message, or read a book. In some cases,
putting a pillow behind your back is a great way to lighten the load on your neck.

Exercises

Pelvic tilt

Lie on your back with your knees bent, heels on the floor and weight on your heels. Press
your back on the floor, contract the buttocks (raising them about 1.5 cm from the floor) and
contract the abdominal muscles. Hold this position for a count of 10. Repeat 20 times.

Knee-thorax stretch

Lie down on your back. Place both hands behind one knee and bring it to the chest. Count to
10. Slowly lower the leg and repeat on the other side. Perform this exercise 10 times.