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Herniated Disc

(Disk, Herniated; Herniation of Nucleus Pulposus [HNP]; Prolapsed Disc; Ruptured Disc; Slipped Disc)

Definition

Discs are small circular cushions between the bones in the spine. The bones are called vertebrae. The discs are compressible. They act as cushions for the vertebrae. A herniated disc happens when discs in the spine bulge from their proper place. This is most common in the lower spine.

Herniated Lumbar Disc

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Copyright © Nucleus Medical Media, Inc.

Causes    TOP

Herniated discs can occur when discs lose water content, become flatter, and provide less cushioning. It can also occur when the disc is damaged by trauma.

Risk Factors    TOP

These factors increase your chance of developing a herniated disc:

  • Age: 30s and 40s
  • Trauma from a fall, accident, or sudden twisting
  • Strain on the back—either repeated or sudden, as from lifting a heavy weight
  • Certain jobs that require heavy lifting
  • Smoking
  • Obesity
  • Diabetes

Symptoms    TOP

Symptoms may include:

  • Pain
    • May be sharp, dull, piercing, aching, burning, or throbbing, depending on the disc and size of herniation
    • May spread over the back, buttocks, down the back of one thigh, and into the calf
    • May be in one leg or both legs
  • Numbness, tingling, or weakness in the legs, feet, or in one or both arms
  • In severe cases, inability to find comfort even lying down
  • Sudden aching or twisted neck that cannot be straightened without severe pain
  • Cauda equina syndrome—involves bowel or bladder changes and/or numbness in the groin
    • Note: This is an emergency, call for medical help right away.

Diagnosis    TOP

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your spine will be examined. The movement, strength, and reflexes of your arms and legs will be tested.

Images may be taken of your bodily structures. This can be done with:

  • MRI
  • CT scan
  • Bone scan

Treatment    TOP

Staying active may be better than bed rest. Treatments may include:

Physical Therapy

The following therapies may be used:

  • Back or neck massage and physical therapy to:
    • Relax the neck or back muscles
    • Decrease pain
    • Increase strength and mobility
  • Back and abdominal exercises
  • Hot or cold packs to reduce pain and muscle spasms
  • Chiropractic care
  • Using weights and pulleys to relieve pressure on the discs and keep you from moving around
  • A neck collar or brace for a herniated disc in the neck to relieve muscle spasms

Medications

Your doctor may advise:

  • Over-the-counter pain medications, such as ibuprofen or naproxen
  • Prescription pain medication
  • Muscle relaxants to reduce muscle spasms

Interventional Spine Care    TOP

Interventional spine care treatments may include:

  • Steroid injections into the area around the nerve and disc to reduce pain and inflammation; the injections are used if other medications do not work
  • Minimally invasive procedures may include:
    • Nucleoplasty
    • Intradiscal electrothermy (IDET)
    • Chemonucleolysis

Surgery    TOP

Surgery may be used for people who fail to respond to other treatments. Immediate surgery is necessary for cauda equina syndrome. Options include:

  • Laminectomy —removal of some of the bone over the spine and of the problem disc
  • Microdiscectomy —removal of fragments of herniated disc through a small incision; this procedure is also known as intervertebral discectomy
  • Spinal fusion —fusing of vertebrae together with bone grafts or metal rods; this is rarely done for first-time disc problems

Prevention    TOP

To help reduce your chances of getting a herniated disc, take the following steps:

  • Practice good posture. Stand and sit straight, and keep your back straight when lifting.
  • Maintain a healthy weight.
  • Exercise regularly. Ask your doctor about exercises to strengthen your back and stomach.
  • Don't wear high-heeled shoes.
  • If you sit for long periods of time, use a stool to bring your knees above your hips.

RESOURCES:

American Academy of Orthopedic Surgeons
http://orthoinfo.aaos.org
American Chiropractic Association
http://www.acatoday.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References:

Awad JN. Moskovich R. Lumbar disc herniations: surgical versus nonsurgical treatment. Clinical Orthopaedics & Related Research. 2006;443:183-197.
When you have a herniated disc. Am Fam Physician. 2003 May 15;67(10):2195-2196. Available at: http://www.aafp.org/afp/2003/0515/p2195.html . Accessed November 22, 2013.
Last reviewed November 2013 by John C. Keel, MD; Michael Woods, MD
Last Updated: 11/22/2013