(Herniation of Nucleus Pulposus [HNP]; Prolapsed Disc; Ruptured Disc; Slipped Disc)
A herniated disc is a bulging of one of the small, round discs between the bones of the spine. A disc that bulges from its proper place puts pressure on spinal nerves. It can cause pain and weakness in limbs. Problems are more common in the lower spine.
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Common causes are:
- The natural aging process (most common cause)
- Poor posture and body mechanics
- Too much pressure on the spine, such as from an inactive lifestyle
- Recent trauma, such as a fall or motor vehicle accident
This problem is more common in older adults. Other things that may raise the risk are:
- A history of low back pain
- Long periods of standing and bending forward
- Strenuous activities, such as heavy lifting
- Genetic problems related to discs
The main symptom is pain that may:
- Be sharp, dull, piercing, aching, burning, or throbbing
- May spread over the back, buttocks, down the back of one thigh, and into the calf or through shoulders and arms
- Be in one leg or both legs or arms
Other problems may be:
- Numbness, tingling, or weakness in the legs, feet, or in one or both arms
- A sudden aching or twisted neck that cannot be straightened without feeling pain
- Numbness in the groin (rare)
- Bowel or bladder changes (rare)
The doctor will ask about symptoms and past health. A physical exam will be done. It will focus on the spine. Images may be taken of the spine. This can be done with:
Most people start to feel better in a few days or weeks. Staying active may be better than full rest. The goal of treatment is to manage symptoms. Choices are:
- Supportive care, such as not sitting for long periods of time, avoiding things that cause pain, and using cold or warm compresses
- Physical therapy to promote strength, flexibility, and range of motion
- Medicines, such as:
- Over-the-counter or prescription pain relievers
- Steroid injections to ease pain and swelling
People who are not helped by these methods may need surgery. Choices are:
- Laminectomy to remove some of the bone over the spine and problem disc
- Microdiscectomy to remove fragments of herniated disc through a small incision
- Spinal fusion to fuse vertebrae together with bone grafts or metal rods (rare)
Exercise and improved strength may help some prevent herniated discs.
North American Spine Society
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Deyo RA, Mirza SK. CLINICAL PRACTICE. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016 May 5;374(18):1763-1772.
Herniated disk in the lower back. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back. Accessed February 17, 2021.
Lumbar disk herniation. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/lumbar-disk-herniation. Accessed February 17, 2021.
Last reviewed February 2021 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM Last Updated: 2/17/2021