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Herniated Intervertebral Disc l: Introduction

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Intervertebral disc herniation develops when the nucleus pulposus protrudes through a tear or weakness in the annulus fibrosus.

The displaced disc material may extend beyond the disc space and compress nearby spinal nerve roots, or, less commonly, the spinal cord.

Most herniations result from degenerative disc changes, often aggravated by trauma or repetitive strain. Risk factors include aging, occupations involving frequent bending or twisting, and high-impact sports such as wrestling.

The lumbar spine, especially at L4–L5 and L5–S1, is most commonly affected due to the high mechanical load it bears. Cervical herniations, particularly at C5–C6 and C6–C7, are also seen.

The hallmark symptom is radiculopathy, or nerve root pain, often with tingling or weakness along the path of the affected nerve.

Lumbar herniations often produce sciatica, with pain radiating from the lower back into the buttock, leg, or foot.

Cervical herniations typically cause neck pain radiating into the shoulder, arm, or hand.

Overview

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Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.

Etiology and Risk Factors

Herniation commonly results from degeneration, in which aging reduces disc hydration and elasticity, weakening the annulus and ligaments. Trauma or mechanical strain, such as heavy lifting or twisting, can precipitate herniation. Risk factors include improper lifting, repetitive strain, high-impact sports, sedentary lifestyle, obesity, smoking, prolonged driving, and congenital factors like ligament laxity.

Common Locations

The lumbar spine (L4–L5, L5–S1) is most affected due to high stress, followed by the cervical spine (C5–C6, C6–C7), while thoracic involvement is rare.

Clinical Manifestations

The key feature is radiculopathy, causing pain, sensory changes, weakness, and reflex alterations along nerve distribution.

Lumbar herniation presents with low back pain radiating to the leg (sciatica), reduced mobility, tenderness, sensory loss, and weakness (L4—knee extension, L5—dorsiflexion, S1—plantarflexion). Reflex changes include reduced patellar (L4) and Achilles (S1) reflexes.
Cauda equina syndrome, a medical emergency, causes bilateral weakness, saddle anesthesia, bladder/bowel dysfunction, and sexual impairment.
Cervical herniation causes neck pain radiating to the arm, with sensory changes and weakness (biceps C5–C6, triceps C7). Reflex loss includes the biceps (C5–C6) and triceps (C7).
Cervical Myelopathy is severe cord compression, which causes upper motor neuron signs below the lesion and lower motor neuron signs at the level, progressing to gait difficulty, loss of coordination, sensory changes, and bladder dysfunction.

Transcript

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