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What is a Herniated Disc?
Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock
absorber).
normal disc, vertebra, nerves

A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body's weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.

herniated disc

The progression to an actual HNP varies from slow to sudden onset of symptoms. There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.

?disc
Progression of Herniated Disc

The extremities affected are dependent upon the vertebral level at which the HNP occurred. Consider the following examples:

Cervical - Pain in the neck, shoulders, and arms
Thoracic - Pain radiates into the chest
Lumbar - Pain extends into the buttocks, thighs, legs

Cauda Equina Syndrome occurs from a central disc herniation and is serious requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter.

Diagnosis of a Herniated Disc
The spine is examined with the patient laying down and standing. Due to muscle spasm, a loss of normal spinal curvature may be noted. Radicular pain (inflammation of a spinal nerve) may increase when pressure is applied to the affected spinal level.

A Lasegue test, also known as Straight-leg Raising Test, is performed. The patient lies down, the knee is extended, and the hip is flexed. If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed.

Other neurological tests are performed to determine loss of sensation and/or motor function. Abnormal reflexes are noted as these changes may indicate the location of the herniation.

Radiographs are helpful, but Computed Axial Tomography (CAT) or Magnetic Resonance Imaging (MRI) provides more detail. The MRI is the best method enabling the physician to see the soft spinal tissues unseen in a conventional x-ray.

Radiographic Evidence of HNP

herniated disc

The findings from the examination and tests are compared to make a proper diagnosis. This includes determining the location of the herniation so treatment options can be reviewed with the patient.

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ABOUT US

Belltown Spine & Wellness, an integrated health and spinal rehabilitation center, has helped thousands of people over the past 22 years regain their health and vitality through their natural, integrated approach to health and wellness in the greater Seattle area. Our services, which include chiropractic, spinal rehabilitation, massage therapy, acupuncture, naturopathic medicine and medical weight-loss are customized and targeted for each individual's health goals. Our signature 4-step program is specifically designed to help patients recover from neck and back pain chronic conditions. This system, created by Dr. Scott Mindel, Seattle chiropractor and owner of Belltown Spine & Wellness draws on the latest rehabilitation techniques available today.

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