A herniated disc is when an intervertebral disc bulges or herniates back into the spinal canal. When the disc herniates, it can push on a nerve root or a spinal nerve and causes severe pain. Most herniated discs resolve over time, but they can be very painful during the healing process. A disc bulge involves >90 degrees of the total circumference of a disc and does not extend beyond the boundaries of the annulus fibrosus.
A disc herniation is a rupture of disc material beyond the annulus fibrosus. There are two broad categories, protrusion and extrusion. Protrusion refers to a rupture of disc material in which the base is broader than the dome. In general, this does not extend above or below the disc space. An extrusion is a disc rupture in which the dome is wider than the base, with a dumbbell appearance. Extrusions may extend above or below the disc space.
A free fragment is a displacement of disc material that loses its connection with the main disc material. Such fragments can migrate from the disc space.
Herniated discs can be caused by a number of things including trauma, lifting heavy objects, or using poor posture throughout the day.
How can it be treated?
Herniated disc treatment starts conservatively with physical therapy and medication management. If the pain does not resolve, the patient may be a candidate for an epidural steroid injection, spinal cord stimulation, or other surgical intervention.