A herniated lumbar disc is not a condition that suddenly appears at a particular age; it is the result of poor posture and lifestyle habits building up over a long time. In fact, about 20% of all patients are in their 20s and 30s, a figure also confirmed in 2018 statistics from the Korean Neurosurgical Society. This article covers the causes and symptoms of herniated discs in younger people, and the nerve block procedure.
Is a herniated disc caused only by ageing?
Between the vertebrae sits the intervertebral disc, a soft structure that absorbs shock, made of a tough outer layer called the annulus fibrosus and a soft inner core called the nucleus pulposus. When poor posture, a habit of repeatedly lifting heavy objects and a lack of exercise combine, the nucleus can be pushed out beyond the annulus and press on a nerve, causing pain and nerve symptoms. This is called lumbar disc herniation, commonly known as a herniated disc.
According to 2018 statistics from the Korean Neurosurgical Society, patients in their 20s and 30s account for about 20% of the total. Sitting for long periods raises the pressure on the lower back considerably compared with standing, a hunched posture that becomes fixed builds up strain on the spinal muscles, and a weak core or weight gain also increases the load on the disc.
- Sitting for long periods — pressure on the lower back is higher than when standing, increasing the strain on the disc
- Hunched posture — once poor posture becomes fixed, strain builds up on the muscles around the spine and on the disc
- Lack of exercise and a weak core — when weight gain and reduced muscle strength combine, the load on the disc increases
What symptoms does a herniated disc cause?
In the bulging stage, when the nucleus swells within the annulus, it is easy to dismiss as a dull ache when sitting for a long time, but in the protrusion stage, when part of the annulus tears and irritates a nerve, radiating pain and abnormal sensations become clear. In the extrusion stage, when the annulus ruptures completely and the nucleus leaks out, severe radiating pain and difficulty walking can appear, and in rare cases it can lead to bladder or bowel problems or paralysis, so the pain should not be taken lightly.
- Bulging stage — the nucleus swells within the annulus, causing a dull ache when sitting for a long time and stiffness in the morning
- Protrusion stage — part of the annulus tears and irritates a nerve, causing radiating pain and abnormal sensations, with pain worsening on coughing
- Extrusion stage — the annulus ruptures and the nucleus leaks out, causing severe radiating pain and difficulty walking, and rarely even paralysis
What is a nerve block, and can it be given at any time?
A nerve block is a representative non-surgical treatment in which medication is carefully injected around the area where a nerve is compressed, reducing inflammation and swelling to ease pain, on a principle similar to spraying a fire extinguisher where a fire has started. A combination of long-used medications such as lidocaine, steroids and antibiotics is injected after local anaesthesia, so even older patients or those with systemic conditions can undergo the procedure in a relatively stable manner.
However, having an injection straight away just because there is pain can be a problem, because the approach differs depending on the cause, the location of the lesion and the shape of the nerve, and performing it without a precise diagnosis makes it difficult to achieve an effect. The key is for the injection to spread sufficiently near the nerve and to the epidural lesion, and its effect drops if it is placed around the bone, so appropriate timing and a precise diagnosis need to go together.
