A pathological herniated disc is definitively proven to create symptoms by negatively influencing a nerve or compromising the stability of the spine. While true disc pathologies are rare, they do exist and can cause serious neurological consequences in the spinal anatomy. However, it must be made absolutely clear that most disc abnormalities are not pathological in any way and do not create symptoms. In essence, they are incidental to any discomfort that might exist.
Unfortunately, many patients are not aware that most intervertebral herniations are not only harmless, but are virtually universally experienced in the general population. These conditions have been exhaustively studied by modern medical science and have been cleared of being inherently harmful or symptomatic in any way. However, when circumstances align in particular ways, herniated discs of all diagnostic classifications can cause pain, tingling, numbness and weakness in large areas of the body through the processes of central spinal stenosis, neuroforaminal stenosis, chemical radiculitis and structural instability.
This report helps patients to understand some basic truths of herniated discs, as well as improve their chances of correct diagnostic processing of pathological and non-pathological spinal disc abnormalities.
True disc pathologies are the least common type of herniated intervertebral spacers. These discs have been thoroughly studied and demonstrate proof positive that they are creating ongoing pain or neurological deficit due to one of several possible processes. Simply existing in the spinal anatomy does not cause a disc irregularity to be classified as pathological. In fact, as we detail in the section below, virtually all disc herniations are asymptomatic or only temporarily symptom-generating.
True pathological spinal discs have shown themselves to be harmful and the symptoms have been traced to the disc origin through proper diagnostic processing, including medical imaging, nerve conduction testing and elimination of any other possible causation. However, it is vital to remember that discs do not feel pain themselves. Instead, the underlying reason why they generate symptoms includes any of the following pathological changes to the spinal anatomy:
Central spinal stenosis is most often associated with central herniated discs in patients who also demonstrate other contributors to the canal narrowing at the same level, such as osteoarthritis, ligamentous ossification or hypertrophy or some manner of vertebral misalignment, like spondylolisthesis, or change to typical curvature, such as scoliosis, lordosis or kyphosis. In cases of central stenosis in the neck, upper back and middle back, the spinal cord may suffer compression within the central canal. In the lower back, the cauda equina can suffer compression en masse or to particular roots within the central canal space. These occurrences can cause a wide range of possible symptoms anywhere below the affected region of the spine.
Neuroforaminal stenosis can affect one or more of the foramen and is usually seen in association with paracentral, foraminal and extraforaminal herniated discs. In many cases, the disc problem is compounded by arthritic accumulations within the foraminal openings or around the spinal facet joints. Symptoms of nerve compression will be expressed in tightly defined locations and should progress as expected clinically from pain to paresthesia to full numbness to weakness and dysfunction in most instances.
Chemical radiculitis is a far more debated diagnosis, since it is more subjective in terms of who it might affect rather then the exact circumstances of why it might exist. Many patients suffer annular tears, intervertebral rupture and subsequent migration of disc nucleus proteins onto nearby nerve tissues. Most people do not experience symptoms, while a small percentage seem sensitized to this protein more than their asymptomatic peers.
Changes to the structural integrity of the spine might occur in dire and structurally significant disc collapse or herniation events, often in combination with serious spinal curvature or misalignment abnormalities. In these instances, the pain might be neurological or mechanical and often requires treatment using the most invasive methods available.
Disc pathologies are different than disc abnormalities. In fact, most doctors now agree that what was once considered “abnormal” in the spine should now be viewed as “completely normal and virtually universally expressed”. Doctors now know that bulging discs are found in more people than not, especially in the mid to low neck and low lumbar spinal zones. Most of these conditions are not at all painful, while a minority of disc irregularities are painful for a short time, but will resolve without any special care needed. This statement holds true regardless of the structural severity of the herniation, rupture or extrusion.
Doctors have found all manner of intervertebral abnormalities in people who have no history of back or neck pain. In fact, the disc conditions imaged in these patients are often considered severe to extreme by diagnostic classification, often entailing a complete migration of disc nucleus from the annulus fibrosus, or large areas of intact bulging, often into the thecal sac, yet no symptoms exist.
Herniated discs are rarely misdiagnosed as existing or not, but are certainly misdiagnosed as the cause of pain in the majority of people who are aware of one or more intervertebral bulges in their spines. This fact truly explains why disc pain treatment is so unsatisfying, since the disc being treated is seldom the actual origin of suffering. While herniated discs exist in the necks and/or lower backs of most people, pathological herniations are rare and often resolve all by themselves.
The good news is that truly pathological and chronic disc conditions respond the very best to indicated treatment. One of the main reasons for this to occur is the surety of the diagnosis, especially when most patients are misdiagnosed as suffering from a coincidental herniated disc that is not the real source of pain.
Conservative care might help to reduce the symptoms of some pathological discs, but there are few curative methods that can actually resolve the condition completely. These curative approaches include nonsurgical spinal decompression and surgical intervention. Obviously, noninvasive care is preferred when indicated, but surgery can still serve patients well when it is performed with care and in appropriate circumstances.
The major drawback to disc surgery is the common incidence of recurrence of the herniation in treated tissues, which can spoil surgical outcomes even when all other factors align positively. Spinal decompression does not demonstrate this possibility, nor does it preclude a patient from seeking surgery in the future, if needed. Therefore, spinal decompression earns our nod for the best all-around curative modality for most pathological intact herniations. However, decompression is best applied for contained herniations and a significant rupture, extrusion or sequestration might contraindicate the treatment for particular patients.
Of course, we would be neglectful not to mention that for herniated discs which have been diagnosed as the cause of pain, but in fact are not pathological (which encompasses the vast majority of all disc diagnoses), the best treatment is the application of knowledge therapy to dispel the nocebo effect of the diagnosis and help the patient to recognize the true nature of their pain. Secondary would be no treatment at all, since in many studies, the outcome of “no treatment” fares much better statistically than the result of any particular form of medical or complementary treatment, especially over long timelines of care.