Herniated Disc Back Pain

spinal stenosis

Herniated disc back pain is a dreaded occurrence for many dorsopathy sufferers. The actual words "herniated disc" are enough to cause anxiety and worry over possible agony, surgery and disability. In reality, the spinal disc is a much maligned structure, rarely responsible for the plethora of painful conditions typically blamed on it. This is due to the extremely common nature of disc bulges and ruptures, as well as the universality of disc degeneration.

Herniated discs can occur anywhere in the spine, but are usually found at either end. The cervical spine, also known as the neck, is an area which must bend and flex constantly, as well as hold up the significant weight of the head. The discs in the neck wear out fast from all this movement and degenerative disc disease is often diagnosed in one or more vertebral levels by the age of 30 and sometimes much younger. The lumbar spine, also known as the lower back, is the most common location for degenerative disc disease to occur and these age and activity related changes are usually in effect by the age of 20, especially at L4/L5 and L5/S1. Herniated discs are also common in both of these spinal regions and can occur from injury, normal degeneration or idiopathic reasons.

Herniated discs are thought to create pain in several possible ways. The most common is called foraminal stenosis, also known as a pinched nerve. This condition exists when a bulging or ruptured disc puts pressure on one of the spinal nerve roots which exit the spinal column at every vertebral level. While this situation can occur, it is very rare, since the disc would have to completely close off the neuroforaminal opening under extreme pressure in order to compress the nerve sufficiently. Furthermore, even when this rare event does happen, continued compression of the nerve root will result in absolute lack of sensation. This is objective numbness, not the subjective numbness often experienced by many patients. Additionally, there will be no pain or tingling, although real muscular weakness in the area served by the pinched nerve is likely.

The next possible source of herniated disc back pain is due to spinal stenosis. This is diagnosed when the disc applies pressure to the actual spinal cord, narrowing the spinal canal through which the cord passes. Many cases of spinal stenosis are completely asymptomatic, while occasionally, this condition can be a real problem. The most symptomatic instances of spinal stenosis exist when bone spurs (osteophytes) are the source of the narrowed canal and most disc bulges simply do not create any noticeable effect on the cord.

The third way that herniated disc back pain may be explained is from chemical radiculitis. This is when the proteins from the interior of the disc bleed out of the damaged disc structure and irritate surrounding nerve tissue. This is a controversial diagnosis and is not openly accepted in many medical sectors. It seems that if this condition does indeed exist, it only affects some people with particularly sensitive nerve tissue, since many people suffer severe ruptures and experience no pain at all.

The last possible explanation for disc related back pain is the unusual diagnosis of discogenic pain. In this condition, the damaged disc is said to be the actual source of discomfort, which makes little sense, since intervertebral discs do not have nerves or even a dedicated blood supply. Instead, they are nourished through the cartilaginous end plates which attach the discs to the surrounding upper and lower vertebral bones. Some doctors believe it is the tiny nerves in these endplates which are painful, but that seems highly unlikely, since most patients report pain which is far too great and widespread to be sourced from such tiny and anatomically limited neurological tissues.

In the end, most patients do not enjoy relief from a wide range of conservative treatments or even surgeries directed at herniated discs and degenerative disc disease. This has nothing at all to do with the talent of the doctor or the method of treatment. Instead, therapy fails since the diagnosis is completely wrong. Statistics show that herniated discs are often completely asymptomatic and even those which do cause trouble usually resolve with or without treatment in 6 to 8 weeks. Disc conditions are almost never the real reason for chronic back pain. Once you understand this simple fact, it is easy to see why the condition has such a treatment-resistant reputation... It is not that the damage to the spine is so great; it is instead that the pain is being blamed on a complete innocent and coincidental spinal scapegoat.