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Herniated disc – causes, diagnosis and treatment options

Herniated disc and facet joint syndrome are the most common causes of back pain. Signs of a herniated disc can include severe pain in the area of the spine (cervical, thoracic, or lumbar spine). Due to pain, there is a relieving posture and limited mobility. Many patients experience radiating pain in their arms and/or legs and notice an exacerbation of symptoms when coughing, sneezing, or straining.

What is an intervertebral disc made of?

The intervertebral disc consists of an outer fibrous ring (annulus fibrosus) and a central nucleus (nucleus pulposus). The boundary to the vertebral bodies is made of cartilage. The outer fibrous ring consists of up to 70% water and the inner core up to 90%.

Why does a herniated disc occur?

The intervertebral disc is highly water-rich, and this water content changes in a daily cycle. It dehydrates during the day and replenishes with water at night. If this balance is disturbed, a dehydrated fiber ring can cause the fibers to crack and the inner core to break through. This is referred to as a herniated disc.

What is the cause of a herniated disc?

In 60-70% of all affected patients, there is a family history (genetic predisposition). Known triggering factors include: improper lifting, improper carrying, poor sitting posture, untrained back muscles, overweight, and spinal deformities.

A herniated disc most commonly occurs at the levels of the cervical spine C5/C6 and C6/C7, and in the lumbar spine at L4/L5 and L5/S1. Here, there is the greatest mobility and the highest pressure load of the entire spine (predilection sites).

What are the symptoms of a herniated disc?

  • Pain radiating to the arms and/or legs
  • Symptoms of paralysis (reduction of strength)
  • Sensory disturbance (radicular symptoms)
  • Bladder (micturition disorder/urinary retention) and/or rectal emptying disorder – an immediate neurological-radiological clarification must be carried out here!


  • Neurological examination
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT)

What are the treatment options?

In cases of pain and radicular symptoms (sensory disturbances), an intensive conservative therapy may be initiated for several weeks initially. A nerve root block (CT-guided infiltration – application of a pain medication) can also be used for pain management.
If there is no improvement, surgery can/should be considered.

Absolute indication
for surgery:
– severe paralysis of the arms and/or legs and paralysis of the bladder or rectum
Relative surgical indication:
– persistent pain without neurological deficits over several weeks

Surgical Approach

This involves a minimally invasive surgical procedure. The herniated disc is removed through a small skin incision of a few centimeters and under a surgical microscope. The patient can already get up the next day and the entire hospital stay lasts 4-5 days.
For operations in the cervical spine, the surgical approach is typically anterior (from the front) in most cases. Again, this is a minimally invasive procedure under a microscope. The entire intervertebral disc in the affected spinal segment is removed. This intervertebral disc space is then filled with a placeholder. The length of hospital stay is usually 4 days.

Facet joint syndrome

Facet joint syndrome is pain caused by irritation or blockage of the vertebral joints (facet joints). Spinal osteoarthritis is usually triggered by a reduced distance between the vertebral bodies due to wear and tear, especially in the lumbar spine. The wear and tear of these joints is caused by obesity and poor posture (desk work, manual work, etc.).

Conservative and interventional therapy measures (facet joint injections) are used to treat facet joint syndrome.