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Herniated Disc
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Herniated Disc

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

En Español (Spanish Version)

Definition

Discs are small circular cushions between the vertebrae (bones) in the spine. The discs are compressible and 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

Nucleus factsheet image

© 2008 Nucleus Medical Art, Inc.

Causes

Herniated discs can occur when discs lose water content, become flatter, and provide less cushioning. If they become too weak, the outer part may tear. The inside part may then push through the tear and press on the nerves next to it.

Risk Factors

These factors increase your chance of developing a herniated disc. Tell your doctor if you have any of these risk factors:

  • 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 requiring heavy lifting

Symptoms

Symptoms include:

  • Pain—how severe the pain is depends on which disc is herniated and how large the herniation is
    • Pain may spread over the buttocks, down the back of one thigh, and into the calf
    • Pain may be in one leg (more common) or both legs
  • Numbness, tingling, or weakness in the legs or feet
  • Numbness, tingling, or weakness 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 911.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Your spine will be examined. The doctor will test the movement, strength, and reflexes of the arms and legs.

Tests may include:

  • X-ray—a test that uses radiation to take a picture of structures inside the body, especially bones
  • CT scan— a type of x-ray that uses a computer to make pictures of structures inside the body
  • MRI—a test that uses magnetic waves to make pictures of structures inside the body and allows both the bones and the disc to be seen
  • Diskography—a test that involves injecting a dye into the center of the disc and then taking an x-ray, which may show the dye leaking out
  • Electrodiagnostic testing—a test that measures the electrical activity of muscle by placing needle electrodes into the muscle
  • Myelography—a type of x-ray that uses dye injected in the space around the spinal cord to more clearly outline the space containing the spinal cord and nerves, can show any disc herniation

Treatment

Treatments may include:

Physical Medicine

  • Bed rest
  • During acute phase, back or neck massage and physical therapy to:
    • Relax the neck or back muscles
    • Decrease pain
    • Increase strength and mobility
  • During recovery phase, back and abdominal exercises
  • Hot or cold packs to reduce pain and muscle spasms
  • Stretches for the spine:
    • A doctor or chiropractor can sometimes help reduce pain by stretching your spine.
    • Any spinal manipulation must be done carefully by an experienced, licensed practitioner.
  • Traction (weights and pulleys)—used to relieve pressure on the discs and keep you from moving around (more common for discs in the neck area)
  • Neck collar or brace for a herniated disc in the neck—may be used to relieve muscle spasms

Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)—may be prescribed to reduce inflammation and pain (eg, ibuprofen, naproxen)
  • Muscle relaxants—may be prescribed to reduce muscle spasms
  • Pain medications

Interventional Spine Care

  • Steroid injections—injected into the area around the nerve and disc to reduce pain and inflammation, used if medications does not work
  • Minimally invasive procedures (eg, nucleoplasy, intradiscal electrothermy (IDET), chemonucleolysis)

Surgery

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 overlying the spinal canal and of the protruding disc under that
  • Microdiskectomy—removal of fragments of herniated disc through a smaller incision without doing a laminectomy
  • Spinal fusion—fusing of vertebrae (back bones) together with bone grafts or metal rods (rarely done for first-time disc problems)

Prevention

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://www.aaos.org/

American Chiropractic Association
http://www.amerchiro.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.

Ellenberg M, Honet JC. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Hanley and Belfus; 2002, chap 46.

Goldmann DR. American College of Physicians Complete Home Medical Guide. New York, NY: DK Publishing; 1999.

Slipman CW, Derby R, Simeone FA, Mayer TG. Interventional Spine: An Algorithmic Approach. Philadelphia, PA: Saunders Elsevier; 2008.

When you have a herniated disc. American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html. Published 2003. Accessed July 2, 2008.



Last reviewed January 2008 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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