Herniated discs can be divided into different categories:

1. Protrusion: Bulging of the disc material without complete tearing of the fibrous ring.
2. Extrusion: The nucleus pulposus protrudes through the fibrous ring but remains connected to the disc.
3. Sequestration: The disc material completely detaches from the disc and lies free in the spinal canal.
4. Medial herniation: The disc presses on the spinal cord.
5. Lateral herniation: The disc presses on the nerve roots.

The main causes of a herniated disc can be divided into several categories:

- Degenerative changes:

- With increasing age, the intervertebral discs lose elasticity and moisture, making them more susceptible to tears and herniation.

- Improper loading:

- Incorrect lifting of heavy objects or poor posture when sitting and working increases the pressure on the intervertebral discs.

- Lack of exercise:

- A weak core musculature cannot adequately support the spine, increasing the risk of herniation.

- Overweight:

- Additional body weight puts more strain on the intervertebral discs and promotes their wear.

- Traumatic events:

- Sudden, severe stresses such as falls or accidents can trigger a herniated disc.

The symptoms of a herniated disc depend on the location and extent of the herniation. Common complaints include:

- **Back pain:** Acute or chronic pain in the area of the affected spine.

- **Radiating pain:** Pain that radiates into the arms or legs, especially in cases of cervical or lumbar spine herniations.

- **Numbness:** Sensory disturbances or tingling in the extremities, depending on the affected nerves.

- **Movement restrictions:** Stiffness and difficulty performing normal movements.

- **Muscle weakness:** Loss of muscle strength, particularly in the arms or legs.

- **Bladder and bowel dysfunction:** In severe cases, problems with urination or bowel movements may occur, which is a medical emergency.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- Medical history: The doctor inquires about the patient's medical history, existing symptoms, and possible triggers of the complaints.

- Physical examination: Testing of reflexes, muscle strength, and sensitivity to determine the affected nerve roots.

- Imaging techniques:

- MRI: Visualization of disc damage and nerve compression.

- CT: Alternative when an MRI is not possible, for assessing bony structures and soft tissues.

- X-ray: Exclusion of fractures or other bony changes.

Conservative Therapy

Most herniated discs can be treated without surgery:

• Pain Therapy:
  • Use of painkillers and anti-inflammatory medications to alleviate acute symptoms.
• Physiotherapy:
  • Stretching Exercises: Promote mobility and relieve the affected disc.
  • Strengthening Exercises: Strengthen the core muscles to support the spine.
• Manual Therapy:
  • Mobilization of blocked vertebral joints and relief of nerve structures.
• Heat and Cold Therapy:
  • Reduction of tension and inflammation through targeted applications.
• Infiltrations:
  • X-ray-guided injections of local anesthetics or cortisone for pain relief and anti-inflammation.

Surgical Therapy

Surgery is only considered if conservative measures do not provide relief or neurological deficits occur:

• Micro-surgical Discectomy: Removal of the herniated disc material through a minimally invasive procedure.
• Endoscopic Procedures: Minimally invasive removal of disc tissue using an endoscope.
• Stabilizing Procedures: Fusion or stabilization of the affected spinal segment in case of instability.

To prevent herniated discs, the following measures are recommended:

1. Regular exercise: Building and maintaining strong core muscles through targeted training.
2. Proper lifting technique: Avoiding jerky lifting of heavy loads by bending the knees and keeping the load close to the body.
3. Ergonomic work: Adjusting the workplace to promote a healthy sitting posture.
4. Weight control: Avoiding overweight to relieve the spine.
5. Regular breaks: Interrupting prolonged sitting or standing with active movement breaks.