When there is damage to the disk, pieces of the nucleus or the end-plate can rupture through the annulus and compress the nerve elements like a nerve, group of nerves, or spinal cord, depending on the amount of material that has herniated out and the location of the fragment, as well as the location of the disk within the spinal axis (cervical, thoracic, and lumbar). Some patients have disk herniations with only minimal symptoms, while others may be severely impaired or disabled. The treatment should be directed at treating the cause of the symptoms, so therefore the symptoms should be the primary determinant of the treatment strategy, although there are other factors that may change the treatment strategy.
Many disk herniations will get reabsorbed by the body, while others will not. This process may take 6 months or more, if it happens at all. Even for those in whom the fragments could be reabsorbed, not all patients will tolerate the wait for the body to reabsorb the disk components that have migrated to where they do not belong. The symptoms from nerve compression or disk herniations, if present, may include pain in the back or neck, pain radiating (shooting) down the arm or leg, weakness, numbness, or impairment of bowel or bladder function. The severity of the symptoms, the duration of the symptoms, and the patient’s overall condition will deterimine the treatment strategy.
Disk herniations can be treated by various forms of physical therapy and stretching activities, activity restrictions, anti-inflamatories, dietary changes and weight loss, injections, and when other courses of action have either failed or if the symptoms will not tolerate conservative management, by surgery. The treatment algorithm is different in the cervical, thoracic, and lumbar regions due to differences in rates of spontaneous improvement, biomechanical differences between the regions, as well as the type of tissue being compressed (the spinal cord in the cervical and thoracic regions does not tolerated compression as well as the nerve roots in the majority of the lumbar spine, for example). The individual treatment strategy for each patient needs to be tailored to their individual anatomy and symptoms, so the treatment plan needs to be devised with a clinician who is knowledgeable of all aspects of treatment, one who knows how to manage the full spectrum of treatments, and knows to whom the patient should be referred for where they are in their symptoms or recovery phase.
Circumstances that predispose to disk herniations and back problems include obesity and lack of core (abdominal, neck, back muscle) strength. One of the most important aspects of back and disk problem management, for treatment as well as prevention, is the combination of core/back strengthening and weight reduction (imagine if it hurts to stand or walk, how much more it would hurt if the person were carrying an extra 20 pound weighted vest, or how much better they would feel if they could wear a helium vest that took 20 pounds off their feet and back). This is more important the more the patient’s body mass index is over 25 or so. All weight loss should be done in conjunction with a medical professional, so it would be a good idea to discuss any weight loss goals with your primary physician prior to undertaking them.