Why Does My Herniated Disc Keep Coming Back?

Recurring Disc Herniations: Causes, Prevention, and Long-Term Solutions

A herniated disc can be a painful and debilitating condition, affecting your quality of life and limiting your daily activities. For many individuals who have experienced a herniated disc, the fear of recurrence looms large. If you have found yourself asking “Why does my herniated disc keep coming back?” you are not alone. As you read this article, you will learn the reasons behind recurrent disc herniation, risk factors, and strategies to prevent future occurrences.

Understanding Herniated Discs

Before exploring the reasons for recurrence, it is essential to understand what a herniated disc is and how it occurs. A herniated disc, also known as a slipped or ruptured disc, happens when the soft inner core (nucleus pulposus) of an intervertebral disc pushes through a tear in the tough outer layer (annulus fibrosus). This can lead to pressure on nearby nerves, causing pain, numbness, and weakness in the affected area.

Why Herniated Discs Recur

Several factors contribute to the likelihood of a herniated disc recurring:

• Incomplete healing – One of the primary reasons for recurrence is incomplete healing of the annular rent (the tear in the disc’s outer layer) after the initial herniation or surgery. When the annular defect does not seal completely, it remains a weak point exposed to mechanical pressure changes within the disc.
• Degenerative disc disease – Any injury to a disc, including surgical intervention, can lead to degeneration of the spinal segment involved. This degenerative process may increase the risk of future herniations in the same or adjacent discs.
• Biomechanical factors – Changes in the spine’s biomechanics following the initial herniation or surgery can alter the distribution of forces across the discs. This redistribution may place additional stress on weakened areas, increasing the risk of reherniation.

Risk Factors for Recurrent Disc Herniation

Several risk factors may predispose individuals to recurrent disc herniation. Understanding these factors can help in developing targeted prevention strategies.

• Gender and age – While findings are mixed, some studies suggest male gender may be associated with a higher risk of recurrence. Age-related findings are inconsistent, with some research indicating a higher risk in younger patients, while others found no significant age-related differences.
• Smoking – Smoking has been consistently identified as a risk factor for recurrent disc herniation. The exact mechanism is not fully understood, but it may be related to decreased disc nutrition, oxygenation, and increased intradiscal pressure due to excessive coughing.
• Occupation and physical activity – Engaging in heavy manual labor, repetitive lifting, or exposure to vibration has been associated with an increased risk of recurrent herniation. Conversely, regular physical exercise may have a protective effect.
• Body mass index (BMI) – Higher body mass index has been identified as a potential risk factor for recurrent disc herniation. Excess weight can place additional stress on the spine, potentially compromising the healing process and increasing the likelihood of reherniation.
• Disc height and Modic endplate changes – Preoperative higher disc height and greater Modic endplate changes (visible on MRI) have been associated with an increased risk of recurrence. These factors may indicate underlying structural vulnerabilities in the spine.

Preventing Recurrent Disc Herniation

While some risk factors, such as age and gender, are beyond our control, there are several strategies you can employ to reduce the likelihood of recurrent disc herniation:

• Strengthen core and gluteal muscles – Developing a strong core and gluteal muscles can provide better support for your spine, reducing the stress on individual discs. Incorporate exercises that target these muscle groups into your fitness routine.
• Maintain proper posture and body mechanics – Practice good posture and use proper body mechanics when lifting objects or performing daily activities. This can distribute forces more evenly across your spine, reducing the risk of reherniation. 
• Quit smoking – If you smoke, consider quitting. Smoking cessation can improve disc health and reduce the risk of recurrence.
• Manage your weight – Maintain a healthy body weight to reduce excess stress on your spine. If you are overweight, losing weight can significantly decrease your risk of recurrent herniation.
• Engage in low-impact exercise – Regular low-impact exercises such as swimming, walking, or cycling can help you maintain spine health without placing excessive stress on your discs. There are lower back pain exercises you can do as well.
• Follow post-treatment guidelines – If you have undergone treatment for a herniated disc, strictly adhere to your healthcare provider’s post-treatment instructions. This may include activity modifications and a gradual return to normal activities.
• Practice stress management – Chronic stress can lead to muscle tension and poor posture, potentially increasing the risk of disc problems. Incorporate stress-reduction techniques such as meditation, yoga, or deep breathing exercises into your daily routine.

Treatment Options for Recurrent Disc Herniation

If you experience a recurrent disc herniation despite preventive measures, several treatment options are available:

• Conservative treatments

Many cases of recurrent disc herniation can be managed with nonsurgical approaches, including:

• Physical therapy
• Pain medication and anti-inflammatory drugs
• Epidural steroid injections
• Chiropractic care
• Acupuncture

• Surgical interventions

In cases where conservative treatments fail to provide relief, surgical options may be considered:

• Microdiscectomy – A minimally invasive procedure to remove the herniated portion of the disc
• Lumbar laminectomy – A surgery that removes part of the vertebral bone to relieve pressure on the spinal cord or nerve roots
• Disc replacement surgery – In some cases, the damaged disc may be replaced with an artificial one.

Recurrent disc herniation can be a frustrating and painful experience, but understanding the underlying causes and risk factors can empower you to take proactive steps in prevention. By implementing lifestyle changes, strengthening key muscle groups, and following proper spine care practices, you can significantly reduce your risk of experiencing repeated disc herniations.

Every individual’s spine is unique, and what works for one person may not be suitable for another. Always consult with a qualified healthcare professional before making significant changes to your exercise routine or treatment plan. With the right approach and consistent effort, you can maintain a healthy spine and minimize the likelihood of recurrent disc herniation, allowing you to lead an active and pain-free life.

If you have a herniated disc that is not responding to conservative treatment, a discectomy may be discussed and potentially recommended. Although this is generally a very successful procedure, having a large hole in the outer ring of the disc more than doubles the risk of needing another operation. A new treatment, Barricaid, is a bone-anchored device that closes this hole, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. 

If you have any questions about the Barricaid treatment, ask your doctor or contact us today.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.