⸺Herniated disk ⸺

Cervical spine, thoracic spine, and lumbar spine: symptoms, causes, and treatment

A herniated disk is one of the most common spinal conditions. The intervertebral disks are located between the vertebrae and consist of a flexible outer layer of tough connective tissue surrounding a gel-like core. A herniated disk occurs when tissue from one of the disks between the vertebrae pushes outward and can press on nearby nerves or the spinal cord. This can cause pain and impaired function.

⸻ Herniated disk

Symptoms of a herniated disks

A herniated disk can occur in the lumbar or cervical spine and, less commonly, in the thoracic spine. It is diagnosed using an MRI and/or CT scan. Disk herniation is most common between the ages of 30 and 50 and is twice as common in men as in women. Not every herniated disk causes long-term pain or functional limitations. MRI scans reveal that up to one-third of adults have a herniated disk without experiencing any symptoms. Research has identified several risk factors for disk herniation, including regularly lifting heavy loads, sports such as weightlifting and hammer throwing, and smoking.

When a disk herniation occurs in the lumbar spine, symptoms can range from deep lower back pain to pain in the legs and buttocks. A cervical herniated disk can cause pain in the neck, shoulder, or arm. Coughing, heavy lifting, and bending can make the pain worse, and the range of motion of the spine may be impaired.

Nonsurgical treatment

Long-term treatment focuses on addressing the underlying causes and other factors that may contribute to a herniated disk. Treatment includes muscle strengthening, weight management, and exercises to improve core and abdominal strength and muscle conditioning. Physical therapy can play an important role in this process. During an acute episode, pain medication can help, and a cervical brace may also be worn temporarily for a herniated disk in the neck.

Surgical treatment

For patients with severe pain, and particularly those with neurological problems, the only effective option is often surgery. Whenever possible, surgery is performed using minimally invasive techniques and with the aid of a surgical microscope. Several surgical techniques are available, generally involving small incisions and short operating times that help patients recover quickly. However, patients with multiple herniated disks or advanced degeneration may require more extensive surgery to relieve their symptoms.

Range of motion of the cervical spine with an implanted artificial disk

Illustration of the mobility of a disc prosthesis on the cervical spine:

Surgery for an artificial spinal disc:

The directions of movement and biomechanical properties
of an intervertebral disc prosthesis (artificial disc):

Herniated disk FAQs

1What is a herniated disk?

Intervertebral disks consist of a tough outer layer and a soft, gel-like core. When a disk herniates, material from the soft inner core pushes through a tear in the outer layer and can press on nearby nerves or the spinal cord. This can cause severe pain, numbness, and tingling.

2What causes disk herniation?

Factors that can contribute to a disk herniation include genetic predisposition, age-related and other degenerative changes, lack of physical activity, and improper loading of the spine.

3What are the typical symptoms of a cervical herniated disk?

If the cervical spine is affected, pain may radiate from the neck into the shoulder, arm, or hand and may be accompanied by weakness, tingling, and numbness. In severe cases, myelopathy may develop, causing symptoms such as an unsteady gait and problems with movement.

4What are the typical symptoms of a thoracic herniated disk?

Patients with a thoracic herniated disk may experience localized pain in the middle of the back or band-like pain radiating around the chest. Tingling and numbness may also be felt in the torso. The pain may worsen when coughing or taking a deep breath.

5What are the typical symptoms of a lumbar herniated disk?

A lumbar herniated disk can cause lower back pain that radiates into the buttock, leg, or foot. The pain may worsen when coughing, sneezing, or sitting. Numbness and tingling may also occur.

6How is a herniated disk treated?

Patients can be treated nonsurgically, for instance with physical therapy, pain medication, targeted exercises, and heat therapy. Those with severe radicular pain may be treated with targeted injections around the affected nerve. Surgery may be considered if severe pain persists or neurological problems develop.

7When is surgery needed?

Surgery is recommended if neurological problems such as paralysis or muscle weakness develop, or in emergency situations involving bladder or bowel dysfunction. Persistent pain lasting six to twelve weeks despite nonsurgical treatment may also be an indication for surgery.

8When is artificial disk replacement an option, and when is spinal fusion more appropriate?

The decision will depend on the underlying cause and the condition of the spine. Implanting an artificial disk is an option if the damage is limited to a single disk, the facet joints are intact, and bone quality is good. Spinal fusion is often more appropriate for patients with spinal instability, osteoporosis, or spondylolisthesis.