Understanding Herniated Discs and the Body's Healing Process

Key Points

• Most herniated or slipped discs improve without surgery.
• Many herniated discs do not cause pain.
• Research shows herniated discs are common in people without associated pain.
• Pain from herniated discs typically subsides over time.

Mechanism of Herniation

• Jelly Donut Model:
  • Nucleus Pulposus: Center of the disc that can rupture.
  • Annulus Fibrosus: Outer woven structure that contains the nucleus.
  • Herniation occurs when the nucleus protrudes through a break in the annulus, similar to jelly spilling from a donut.
  • Breakdown of the annulus fibers can lead to pressure on surrounding tissues and nerves, causing pain.

Body's Response to Herniation

• The body identifies the herniated nucleus as a foreign object.
• Immune Response:
  • Macrophages and Monocytes: Cells that remove the herniated nucleus by breaking it down, likened to "Pac-Man".
• Larger herniations contain more water and dehydrate over time.
• The body gradually reduces the herniation and repairs the tear in the annulus, creating scar tissue.
  • The scarred annulus is weaker and has an increased chance of rereupture.
  • Natural dehydration of the disc continues, potentially leading to a bulge.

Prognosis and Recommendations

• Many people experience spontaneous regression of herniations on MRI over time.
• It's crucial to monitor any severe pain or loss of muscle strength and bladder/bowel control, as these may require immediate medical attention.
• If severe conditions are ruled out, patients can often wait for natural healing, as:

  • 90% of people improve within 6-8 weeks without surgery.

• The take-home message: Tolerating pain and being patient can often eliminate the need for surgical intervention.