Slipped disc - when the disc hernia makes everyday life more difficult

Legs and arms are the main sources of pain

The most typical symptom of a disc hernia is the so-called sciatica pain. This often comes from the back or buttocks and extends into the legs. All pain is always triggered by the nerve that is affected by the disc hernia: most frequently it is the lowest two discs (L4/5 and L5/S1). Herniated discs are referred to as "radicular pain", which originates from the nerve root.

A herniated disc L4/5 causes pain on the front and outside of the thigh due to pressure on the L5 nerve, radiating down the front of the lower leg to the big toe.

A herniated disc L5/S1 tends to cause pain in the back of the thigh and lower leg as far as the sole of the foot and the outer edge of the foot. Pain in the lower back can be severe, especially at the beginning, but then often disappears, so that the main problem with a disc hernia is usually the leg pain and not the back pain. There is also other annoying nerve pain, which can be associated with numbness and discomfort (tingling).

In the case of a disc hernia in the cervical spine, pain radiates into the arms. In some cases, the compressed nerve also leads to more severe neurological disorders such as muscle weakness (paralysis) and, in extreme cases, loss of bladder and rectal function (urinary and faecal incontinence). The latter is known as "cauda syndrome" and is an absolute surgical emergency.

How do you recognise a slipped disc?

During the clinical examination, the pain in the arms and legs can often be assigned to a nerve supply area (dermatome). Neurological tests to check reflexes, sensitivity and muscle strength in the arms and legs (e.g. Lasègue test) usually allow the affected nerve to be localised precisely. Positive nerve stretch tests can confirm the diagnosis of a herniated disc.

After the clinical examination, the best way to make a diagnosis is a magnetic resonance imaging (MRI) scan. If this is not possible, e.g. in patients with pacemakers or non-compatible implants, a CT myelography (computer tomography of the affected section of the spine with contrast medium) is performed to confirm and localise the herniated disc and estimate its extent.

Each case is analysed individually and discussed on an interdisciplinary basis

The seamless cooperation between the rheumatology, pain therapy and spinal surgery departments in the Spine Centre at Bethesda Hospital means that the best treatment is always tailored to the patient's individual situation. Care is taken to ensure that all non-surgical options are exhausted before an operation . The entire non-surgical and surgical treatment spectrum is available in-house. Specialists in neurology and physiotherapy are also involved in a comprehensive treatment concept.

Conservative treatment is often possible and successful in the case of a slipped disc - with the exception of cases with pronounced signs of paralysis or when nerves that control bladder and bowel emptying are affected. Very intense pain despite supportive painkillers can also be a reason for an operation. Intervertebral discs can also heal themselves - in such a case, the leaking disc material dissolves spontaneously or returns to its original position.

Painkillers and physiotherapy for herniated discs

In addition to a wide range of painkillers for pain relief, physiotherapy treatments help to free the pinched nerve, improve the posture and muscular stability of the spine and prevent further overloading by optimising back hygiene. In the acute stage, targeted physiotherapeutically instructed relieving postures can contribute directly to pain relief.

If the pain does not improve, a "minimally invasive therapy procedure" can be selected as the next step. This involves injecting anti-inflammatory medication directly into the nerve using interventional pain therapy under imaging control. This often achieves significant pain relief and avoids the need for surgical treatment.

However, if the disease progresses, it is time to consider an operation and put yourself in the hands of the spinal surgery team at Bethesda Hospital.

Surgery only after all non-surgical options have been exhausted

If the symptoms of the disc hernia persist for longer than 4-6 weeks and conservative treatment (anti-inflammatory medication, physiotherapy, painkiller infiltrations) does not bring any improvement, surgery should be considered.

A mini-surgery can be performed to relieve the affected nerve of the pressure caused by the displaced disc tissue. If the nerve is already so damaged that symptoms of paralysis in the sense of muscle weakness occur, an operation is often even necessary promptly or as an emergency - in such a case, you should by no means wait 4-6 weeks.

Even if surgery is not (yet) an option, spinal surgery experts should be involved at an early stage to help assess the situation. The best possible surgical treatment is the so-called microsurgical disc hernia operation. a small incision is made under the operating microscope to relieve the nerve under pressure and the disc tissue responsible for the pressure is removed. The hospital stay following this very gentle procedure is only two to three nights.

The spinal surgery department at Bethesda Hospital has expertise in all surgical procedures relating to the spine - we will be happy to find the best and most gentle procedure for you.

One fifth of all people affected

Herniated discs typically occur between the ages of 30 and 50. At this time, the disc nucleus still has a relatively large amount of fluid - but the outer protective sheath of the disc (fibrous ring) is already showing signs of wear. In addition to mechanical factors, the extent of wear and tear is also genetically determined.

Men are affected about twice as often as women. For every one disc hernia in the cervical spine requiring treatment, there are ten in the lumbar spine.