Hernia: causes, symptoms, treatment and prevention

Hernia nuclei pulpos (HNP) is a bulging of the soft core of an intervertebral disc (disc). This creates pressure on a nerve root or the spinal cord. What are the causes and symptoms of hernia nuclei pulposi and what are the options for treatment. Can a hernia be prevented? What is PTED?

Article content

  • Hernia
  • Spinal cord
  • Causes of hernia
  • Acute and chronic hernia
  • Hernia symptoms
  • Diagnosis hernia
  • Hernia treatment
  • Percutaneous transforaminal endoscopic discectomy (PTED)
  • How can you possibly prevent a hernia?



You can think of the intervertebral discs as the shock absorbers for the spine. The outer layer is made of connective tissue, the filling is jelly-like. If the filling bulges, a hernia occurs. The intervertebral disc changes shape and puts pressure on the spinal cord or a nerve root. This causes pain. A hernia usually occurs in the lower back, occasionally the intervertebral discs in the neck can also become damaged and very occasionally in the upper back. A hernia almost never occurs in young adults, but after that it becomes more common. Mostly between the ages of forty-five and sixty-five.

Spinal cord

It is the part of the central nervous system that is located in the spine. It runs from the base of the brain to the second lumbar vertebra. The spinal cord is covered by three membranes, these membranes form a whole with the meninges. Outside these membranes there is brain and spinal cord fluid. The spinal cord consists of nerve bundles that transport stimuli between the brain and the rest of the body.

Causes of hernia

From the age of twenty-five, the intervertebral discs slowly dry out. They also become more vulnerable due to the efforts made every day and due to minor damage. The damage can also be caused by a quick bending or twisting movement or because a heavy object is picked up incorrectly. Wrong posture can also lead to a hernia. If you are over forty-five, connective tissue develops around the intervertebral discs. These become more durable over time and the chance of damage decreases.

Acute and chronic hernia

A hernia can be acute or chronic. If an acute hernia is not treated, it almost always turns into a chronic hernia. A chronic hernia is often the result of deterioration of the intervertebral disc. Causes can be: incorrect posture, unhealthy eating, excessive body weight and the normal process that is initiated as you get older. The intervertebral disc loses its strength and power.

Hernia symptoms

A bulging of the soft core does not always have to cause complaints. Only when the nerve roots near the intervertebral discs become compressed, or there is pressure on the spinal cord or on the nerve ligaments, do pain complaints arise. In the case of an acute hernia, the complaints will be serious, such as acute sharp local pain. It is possible that the pain radiates to the legs. People often suffer from muscle cramps and these can change the normal curvature of the back. Then you will see that a bent-over posture is created and a sideways curvature may also occur. With a chronic hernia you often see stiffness and this becomes increasingly worse. This stiffness may be associated with problems with urination or bowel movements. If not treated, permanent incontinence can develop.

Diagnosis hernia

The diagnosis is usually made based on symptoms and examination of the body. During the physical examination, you must do exercises with your back and legs while standing or lying on your back or stomach. The reflexes of the legs and feet are also checked. If a good image has not yet been obtained, an X-ray contrast examination can be performed. Contrast fluid is injected into the lower back with an injection needle and then X-rays are taken of the spine (caudogram). A computed tomogram or CT scan, or Magnetic Resonance Imaging (MRI), can also be performed.

Hernia treatment

There are different ways of treatment. What is chosen depends, among other things, on a person’s condition. Non-operative treatment is usually started in the form of a short period of bed rest, possibly supplemented with medications that relax the muscles and provide rest. Because the condition will deteriorate due to bed rest, even if it is short, physiotherapy or Mensendieck or Cesar is often used. You will then learn to use your back properly and that will lead to a faster recovery.
If surgery is necessary, there are different treatment methods:

  • Chemonucleolysis : an enzyme is injected into the intervertebral disc, the bulge shrivels and the pressure on the nerve will decrease. The treatment is almost never used anymore.
  • Percutaneous discectomy : This can be performed manually or automatically . The treatments are carried out under X-ray control because it is very important where the needle is placed. Manual percutaneous discectomy uses a needle to remove intervertebral disc material using various instruments controlled by hand. Automatic percutaneous discectomy uses a nucleotome. This is a hollow, thin needle that is inserted into the intervertebral disc at the bulge. A vacuum is created in the needle, which causes a piece of the bulged intervertebral disc material to be sucked into the needle and cut off with a very small knife. Water flows through the needle and flushes away the cut material. The hernia will not be gone, but the pain and pressure will become much less. The advantage of the automatic treatment is that the risks of damage and infection are very small, because very fine instruments are used. There are a number of conditions to qualify for this treatment: you must never have had surgery before, it must be a unilateral hernia and you must be younger than forty years old.
  • Furthermore, there is the conventional operation , in which the core of the bulging intervertebral disc is removed and the pressure on the nerve root will disappear. Be well informed, every procedure has pros, cons and risks.


Percutaneous transforaminal endoscopic discectomy (PTED)

Researchers from various Dutch hospitals are investigating whether PTED can compare with standard hernia surgery. PTED is less stressful for the patient. The procedure is performed under local anesthesia and only a small incision of approximately eight millimeters is required on the side of the back. The surgeon uses an endoscope to view the hernia and the hernia is removed with forceps. You can usually go home a few hours after the operation. You will probably recover faster compared to traditional surgery and there may be less scar tissue. More research is needed to obtain more information about possible side effects, for example whether hernia complaints return after a longer period of time. The first research results are expected at the end of 2020. This information will play a role in the decision whether PTED will be included in the basic package.

How can you possibly prevent a hernia?

  • Exercise is very important. If you exercise too little, the muscles will become underdeveloped and the spine will receive too little support.
  • Posture during daily activities is also important. Think of shoes that should fit well (not too tight, not too loose), clothing that should not fit too tight, good posture during a car ride, for example. Make sure you have a good bed, otherwise your back will be strained while sleeping.
  • Maintain a good weight, balanced diet . You can become overweight by consuming the wrong food. If you suffer from strong fat deposits in the abdomen, this will put extra strain on the spine and you will get a hollow back. The spine is also loaded very one-sidedly and damage to the intervertebral discs will occur more quickly.
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