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Abstract

A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. This activity reviews the evaluation and management of lumbar disc herniation and discusses the role of the healthcare team in evaluating and improving care for patients with this condition. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines. Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 777 studies; 7 were eligible for inclusion in the analysis. Further understanding of spinal disc herniation and treatment protocols may help improve evaluation and management in the future. Our research covered a range of management options. Disc herniation is a frequent problem for internists, emergency department doctors, nurse practitioners, and primary care physicians. To manage efficiently, an interprofessional team is needed. The first course of treatment is conservative, with paracetamol and anti-inflammatories being frequently used to relieve pain. A chemist must supervise the use of opioid analgesics in certain situations. Although surgery is sometimes the final option, patients frequently have neurological damage and lingering discomfort. In circumstances where physical treatment is not working, MRI interpretation becomes necessary. Primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues. Results can be enhanced by regular exercise and preserving a healthy body weight.

Introduction & Background

Back discomfort is caused by a herniated disc in the spine, which is a condition in which the nucleus pulposus is displaced from the intervertebral space. Pain may radiate into the lower extremities, be searing or stinging, and be accompanied by changes in sensation or weakening. The disc supports the spine by serving as a cushion against trauma between the vertebral bodies. Pain may occasionally result from the disc compressing a nerve or spinal cord. Although herniated discs can cause pain, there aren't many efficient conservative therapy options. Although refractory instances may require surgical repair or interventional techniques, most cases heal conservatively. When a patient has a herniated disc, the healthcare provider should keep an eye out for any serious neurological abnormalities that can require an immediate referral for neurosurgery [1-3].

When the nucleus pulposus pushes through the annulus fibrous, a thick collagenous ring that surrounds the nucleus pulposus, disc herniation happens. As people age, a degenerative process weakens the nucleus pulposus, which is the most common reason and results in worsening symptoms. Disc herniation is also a result of congenital abnormalities, connective tissue diseases, and trauma. Because of biomechanical pressures, it occurs more frequently in the lumbar and cervical spines, whereas the thoracic spine has a lesser incidence [4].

Localized inflammation and mechanical compression of the nerve by the protruding nucleus pulposus are the causes of herniated discs. The nerve root is compressed in posterior lateral herniations because the annulus fibrosus is thinner and there is less structural support. Clinical myelopathy and spinal cord compression can result from large midline disc herniations. The combination of chemical irritation brought on by inflammation and disc pressure on the longitudinal ligament results in localized back discomfort [2]. Adults with a 2:1 male-to-female ratio who are 3 to 5 years old are prone to herniated discs [5].

Herniated discs can cause pain, tingling, numbness, diminished feeling, weakening, and instability. The most frequent disc in the cervical spine, the C6-7, is the source of radiculopathy. The focus of a physical examination should be on deficiencies and the distribution of sensory abnormalities. The lower region of the thoracic spine is affected by thoracic discogenic pain syndrome, which is frequently brought on by thoracic disc degeneration. The majority of thoracic disc herniations are...(More)

For more info please read, Management of Lumbar Disc Herniation: A Systematic Review, by Cureus