What is a Herniated Disc?

In the course of working with many back pain sufferers, many who have been diagnosed with a disc injury ask me, “What is a herniated disc, anyway?”  I am always amazed that their doctors have not taken the time to explain the exact nature of their spinal abnormality and am even more amazed that they, as patients, never even thought to ask.  I find myself constantly detailing the various types of herniated discs to patients, due to the many individual terms used to diagnose the condition, as well as the variations which occur from one symptomatic expression to the next. “What is a spinal disc?” Intervertebral discs are the cushions in between each vertebral bone in the spine.  These discs serve many functions, including facilitating individual vertebral level movement, providing shock absorption qualities and helping to maintain the natural curvatures of the spine.  Intervertebral discs do not have any direct blood supply and they do not have any interior nerve endings.  Injuring a disc is not inherently symptomatic, since discs, themselves, feel no pain whatsoever. “Can you tell me more about spinal discs?”  Intervertebral discs are very tough structures.  The outside is wall comprised of many layers of thick, interwoven cells and is called the annulus fibrosus.  This name comes from the structures multilayered structure, much like the annular rings of a tree.  The annulus fibrosus gives the disc strength and durability, as well as insulating and preserving the moisture of the nucleus.  The interior of the disc is a softer, pliable gel like material called the nucleus pulposus.  This part of the disc is responsible for providing its moisture content, flexibility and shock absorbing qualities.  Everyday the disc structure starts with a higher moisture content and slowly loses moisture due to bending, flexing and pressure.  Every night the disc moisture content regenerates and the process begins anew… “So, what exactly is a herniated disc again?”  Herniated disc is a general term for an intervertebral spinal disc which has bulged or ruptured, changing its normal shape and position in the spinal column.  Herniated discs which remain intact are also commonly called prolapsed discs, bulging discs, slipped discs or disc protrusions.  Discs which rip open are said to have an annular tear and are also known as ruptured discs.  Discs which actually spill the contents of the nucleus into the body cavity are often called extruded discs or sequestered discs.  As you can see, the nomenclature can get complicated and most patients do not understand the basics of the condition, forget about the specific types of herniations which may occur. “What causes herniated discs to occur?”  The majority of herniations occur due to normal degenerative processes in the spine.  The frightening sounding, but completely normal and universal condition, degenerative disc disease is a spinal aging process which causes discs to dry out and shrink.  Every one of us experiences these changes by the age of 30 and many of us demonstrate them far younger.  DDD, as it is called, is not problematic in the overwhelming majority of people and only in extremely rare cases does it create any pain or neurological symptoms.  However, DDD does facilitate disc herniations.   See, as the disc dehydrates, the nucleus shrinks in mass, circumference and diameter.  This causes unbalanced pressure on the disc as well as the growth of bone spurs (osteophytes) which also wear on the disc.  It is normal for disc degeneration to result in bulges or ruptures as the disc loses structural integrity.  These types of herniations are rarely symptomatic and are usually not even discovered unless coincidently through unrelated spinal imaging.  In other cases, herniations can be created spontaneously when traumatic force is applied to the spinal column.  Generally, the healthier the disc is to begin with and the more force is involved, the greater the chance that the herniation may be painful for at least some amount of time.  It should be noted that a great many herniated discs are discovered after an accident, but in many cases, the bulge or rupture was obviously there long before and degenerative changes provide supportive evidence.  Nevertheless, these herniations are often blamed on the accident and are called “injuries” when in fact, the herniations have existed for months, years or even decades without causing any pain at all… “Can you tell me why herniated discs hurt?”  This is the first tricky question I field daily.  The facts clearly show that most herniated discs do not hurt.  Degeneration induced herniations are almost universally asymptomatic, while herniations from trauma, like any injury, may hurt for some time.  Generally, even the worst symptomatic expressions will resolve with or without any particular treatment in 2 to 8 weeks time.  While back pain is rampant and herniated discs are commonplace, the exact relationship between the 2 has never been firmly established.  In fact, many patients with back pain have terrible agonizing symptoms, but no herniations, while many others, such as myself, have many herniations (9 that I know of in my spine), but no pain at all…

In the course of working with many back pain sufferers, many who have been diagnosed with a disc injury ask me, “What is a herniated disc, anyway?”  I am always amazed that their doctors have not taken the time to explain the exact nature of their spinal abnormality and am even more amazed that they, as patients, never even thought to ask.  I find myself constantly detailing the various types of herniated discs to patients, due to the many individual terms used to diagnose the condition, as well as the variations which occur from one symptomatic expression to the next.

“What is a spinal disc?” Intervertebral discs are the cushions in between each vertebral bone in the spine.  These discs serve many functions, including facilitating individual vertebral level movement, providing shock absorption qualities and helping to maintain the natural curvatures of the spine.  Intervertebral discs do not have any direct blood supply and they do not have any interior nerve endings.  Injuring a disc is not inherently symptomatic, since discs, themselves, feel no pain whatsoever.

“Can you tell me more about spinal discs?”  Intervertebral discs are very tough structures.  The outside is wall comprised of many layers of thick, interwoven cells and is called the annulus fibrosus.  This name comes from the structures multilayered structure, much like the annular rings of a tree.  The annulus fibrosus gives the disc strength and durability, as well as insulating and preserving the moisture of the nucleus.  The interior of the disc is a softer, pliable gel like material called the nucleus pulposus.  This part of the disc is responsible for providing its moisture content, flexibility and shock absorbing qualities.  Everyday the disc structure starts with a higher moisture content and slowly loses moisture due to bending, flexing and pressure.  Every night the disc moisture content regenerates and the process begins anew…

“So, what exactly is a herniated disc again?”  Herniated disc is a general term for an intervertebral spinal disc which has bulged or ruptured, changing its normal shape and position in the spinal column.  Herniated discs which remain intact are also commonly called prolapsed discs, bulging discs, slipped discs or disc protrusions.  Discs which rip open are said to have an annular tear and are also known as ruptured discs.  Discs which actually spill the contents of the nucleus into the body cavity are often called extruded discs or sequestered discs.  As you can see, the nomenclature can get complicated and most patients do not understand the basics of the condition, forget about the specific types of herniations which may occur.

“What causes herniated discs to occur?”  The majority of herniations occur due to normal degenerative processes in the spine.  The frightening sounding, but completely normal and universal condition, degenerative disc disease is a spinal aging process which causes discs to dry out and shrink.  Every one of us experiences these changes by the age of 30 and many of us demonstrate them far younger.  DDD, as it is called, is not problematic in the overwhelming majority of people and only in extremely rare cases does it create any pain or neurological symptoms.  However, DDD does facilitate disc herniations.   See, as the disc dehydrates, the nucleus shrinks in mass, circumference and diameter.  This causes unbalanced pressure on the disc as well as the growth of bone spurs (osteophytes) which also wear on the disc.  It is normal for disc degeneration to result in bulges or ruptures as the disc loses structural integrity.  These types of herniations are rarely symptomatic and are usually not even discovered unless coincidently through unrelated spinal imaging.  In other cases, herniations can be created spontaneously when traumatic force is applied to the spinal column.  Generally, the healthier the disc is to begin with and the more force is involved, the greater the chance that the herniation may be painful for at least some amount of time.  It should be noted that a great many herniated discs are discovered after an accident, but in many cases, the bulge or rupture was obviously there long before and degenerative changes provide supportive evidence.  Nevertheless, these herniations are often blamed on the accident and are called “injuries” when in fact, the herniations have existed for months, years or even decades without causing any pain at all…

“Can you tell me why herniated discs hurt?”  This is the first tricky question I field daily.  The facts clearly show that most herniated discs do not hurt.  Degeneration induced herniations are almost universally asymptomatic, while herniations from trauma, like any injury, may hurt for some time.  Generally, even the worst symptomatic expressions will resolve with or without any particular treatment in 2 to 8 weeks time.  While back pain is rampant and herniated discs are commonplace, the exact relationship between the 2 has never been firmly established.  In fact, many patients with back pain have terrible agonizing symptoms, but no herniations, while many others, such as myself, have many herniations (9 that I know of in my spine), but no pain at all…