Herniated Disc Diagnosis

spinal stenosis

Herniated discs are one of the most common of all spinal abnormalities blamed for causing potentially severe and chronic back pain in multitudes of suffering patients each year. While herniations can be problematic in the short term for a minority of patients, they are rarely responsible for causing the long term or excruciating pain that is inherent to their fearsome reputation.

Herniated discs are the most common of all spinal irregularities. They are diagnosed in untold numbers of people, both with and without back pain. Herniations have become the bread and butter of the back pain industry and even enjoy a plethora of colorful nomenclature attached to their diagnosis. The most common terms associated with disc pathologies include: disc herniation, bulging disc, ruptured disc, prolapsed disc, disc protrusion, slipped disc, collapsed disc and degenerated disc. While these terminologies might have some circumstantial differences to some care providers, they are often used interchangeably, much to the confusion of the affected patient.

Herniated discs are theorized to create back pain through several distinct processes. The most common of these causations is called foraminal stenosis. This condition is often termed a pinched nerve. Foraminal stenosis occurs when a herniation bulges into the neuroforaminal opening, impinging on the nerve root exiting the spine at that vertebral level. While this process can indeed exist, it is diagnosed far more often than it truly occurs. In order for the herniated disc to significantly affect the neurological functionality of the nerve root, the neuroforamen would have to be almost completely sealed off, which is a very rare event. This diagnosis is commonly made even when there is no evidence that the herniation even touches the nerve root in question; forget about actually compressing it...

Spinal stenosis is the second most common disorder blamed on herniated discs. Spinal stenosis describes a condition in which the herniation pushes against the actual spinal cord or cauda equina, limiting full neurological functionality from the entire spinal structure. Spinal stenosis can be a very serious problem and might lead to such devastating symptoms as cauda equina syndrome. Once again however, the diagnosis of spinal stenosis from a bulging disc is made very often, while the actual condition rarely ever exists, except in cases of extreme spinal trauma. Typically, the herniated disc might come in contact with the membrane surrounding the spinal cord and spinal fluid. A disc bulge touching this membrane does not mean that any effect will be passed along to the neurological function of the spinal cord. In fact, many herniations impinge on the thecal sac completely unknown to an affected person, since the disc condition creates no symptoms whatsoever.

Chemical radiculitis is a less typical diagnosis commonly associated with severe annular tears in the outer disc wall or complete disc ruptures. The interior of the intervertebral disc (called the nucleus pulposus) contains proteins which might cause nerve irritation in some individuals. When the nucleus spills out of the disc structure, this protein can affect local nerve tissue, enacting radicular pain in the immediate area and the regions of the body served by the irritated nerve structure. This is a somewhat controversial diagnosis, since many people experience full disc ruptures, yet have no pain at all. It seems that only some people might be sensitive enough to suffer from considerable lasting pain after a chemical radiculitis event occurs.

Finally, discogenic pain is the last and least common of all diagnoses. Discogenic means that the pain comes from the disc structure itself. While the disc has no nerve endings or blood supply of its own, it is attached to the neighbor vertebrae by cartilaginous endplates which do contain tiny nerves. It is these small nerves which are implicated in discogenic pain conditions, although most doctors who make the diagnosis are not always sure why the nerves hurt to begin with. This diagnosis is certainly on very shaky ground in most instances...

Ironically, although herniated discs are blamed for a tremendous amount of pain, they are rarely the actual symptomatic source. Most disc herniations are merely coincidental to any pain experienced and actually exist in a vast number of people who have no pain at all. Generally, herniations due to trauma will most likely cause pain for a short time, although this discomfort might be severe. Luckily, this condition usually resolves in 6 to 8 weeks, even without any medical treatment. Herniations which exist due to the normal degenerative processes in the spine, such as the laughably named degenerative disc disease, are rarely painful, even in the short term. Most of these degenerative induced bulges are not even discovered till many years later, since they raise no warning signs, cause no pain and exist innocently in the spine. The possibility that any herniated disc might cause pain for months, years or even decades is highly unlikely. Unfortunately, the mythology surrounding disc conditions, as well as the considerable nocebo effect of the diagnostic process, have both contributed to the current epidemic of disc related back pain.

As a final thought, remember that herniated discs are a huge industry in the medical sector. Doctors, chiropractors, complementary therapists, drug manufacturers, pharmaceutical suppliers, orthotic makers and a variety of other entities all profit hugely from disc pain. If the reality of the average herniated disc ever became common knowledge, the viability of this extremely profitable business niche would be decimated. Therefore, do not count on the diagnosis of disc herniations as a major source of pain decreasing any time soon.