Herniated disk

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000442.htm

A herniated (slipped) disk occurs when all or part of a spinal disk is forced through a weakened
part of the disk. This places pressure on nearby nerves.

Causes

The bones (vertebrae) of the spinal column run down the back, connecting the skull to the pelvis.
These bones protect nerves that come out of the brain and travel down your back, forming the
spinal cord. Nerve roots are large nerves that branch out from the spinal cord and leave your
spinal column between each vertebrae.
• The spinal vertebrae are separated by disks filled with a soft, gelatinous
substance. These disks cushion the spinal column and space between your
vertebrae.
• These disks may herniate (move out of place) or rupture from trauma or
strain. When this happens, the spinal nerves may become compressed,
resulting in pain, numbness, or weakness.
• The lower back (lumbar area) of the spine is the most common area for a
slipped disk. The cervical (neck) disks are affected 8% of the time. The upper-
to-mid-back (thoracic) disks are rarely involved.
Radiculopathy refers to any disease that affects the spinal nerve roots. A herniated disk is one
cause of radiculopathy (sciatica).
Disk herniation occurs more frequently in middle-aged and older men, especially those involved
in strenuous physical activity. Other risk factors include any conditions present at birth
(congenital) that affect the size of the lumbar spinal canal.

Symptoms

Low back or neck pain can vary widely. It may feel like a mild tingling, dull ache, or a burning
or pulsating sensation. In some cases, the pain is severe enough that you are unable to move. You
may also have numbness.
The pain most often occurs on one side of the body.
• With a lumbar (lower back) herniated disk, you may have sharp pain in one
part of the leg, hip, or buttocks and numbness in other parts. You may also
feel the sensations on the back of the calf or sole of the foot. The affected leg
may feel weak.
• With a cervical (neck) disk herniation, you may have pain when moving your
neck, deep pain near or over the shoulder blade, or pain that radiates to the
upper arm, forearm, or (rarely) fingers.
The pain often starts slowly. It may get worse:
• After standing or sitting
• At night
 • When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards, especially if it is
caused by spinal stenosis
You may also have weakness in certain muscles. Sometimes, you may not notice it until your
doctor examines you. In other cases, you will notice that you have a hard time lifting your leg or
arm, standing on your toes on one side, squeezing tightly with one of your hands, or other
problems.
The pain, numbness, or weakness often will go away or improve a lot over a period of weeks to
months.

Exams and Tests

A physical examination and history of pain may be all that your health care provider needs to
diagnose a herniated disk. A neurological examination will evaluate muscle reflexes, sensation,
and muscle strength. Often, examination of the spine will reveal a decrease in the spinal
curvature in the affected area.
Leg pain that occurs when you sit down on an exam table and lift your leg straight up usually
suggests a herniated lumbar disk.
A foraminal compression test of Spurling is done to diagnose cervical radiculopathy. For this
test, you will bend your head forward and to the sides while the health care provider puts slight
downward pressure on the top of your head. Increased pain or numbness during this test is
usually a sign of cervical radiculopathy.
DIAGNOSTIC TESTS
• Spine x-ray may be done to rule out other causes of back or neck pain.
However, it is not possible to diagnose a herniated disk by spinal x-ray alone.
• Spine MRI or spine CT will show spinal canal compression by the herniated
disk.
• EMG may be done to determine the exact nerve root that is involved.
• Nerve conduction velocity test may also be done.
• Myelogram may be done to determine the size and location of disk
herniation.

Treatment

The first treatment for a herniated disk is a short period of rest with pain and anti-inflammatory
medications, followed by physical therapy. Most people who follow these treatments will
recover and return to their normal activities. A small number of people need to have further
treatment, which may include steroid injections or surgery.
MEDICATIONS
Nonsteroidal anti-inflammatory medications (NSAIDs) and narcotic painkillers will be given to
people with a sudden herniated disk caused by some sort of injury (such as a car accident or
lifting a very heavy object) that is immediately followed by severe pain in the back and leg.
If you have back spasms, you will usually receive muscle relaxants. On rare occasions, steroids
may be given either by pill or directly into the blood through an IV.
NSAIDs are used for long-term pain control, but narcotics may be given if the pain does not
respond to anti-inflammatory drugs.
LIFESTYLE CHANGES
Diet and exercise are crucial to improving back pain in overweight patients.
Physical therapy is important for nearly everyone with disk disease. Therapists will tell you how
to properly lift, dress, walk, and perform other activities. They will work on strengthening the
muscles that help support the spine. You will also learn flexibility of the spine and legs.
See: Taking Care of Your Back at Home
INJECTIONS
Steroid injections into the back in the area of the herniated disk may help control pain for several
months. Such injections reduce swelling around the disk and relieve many symptoms. Spinal
injections are usually done on an outpatient basis, using x-ray or fluoroscopy to identify the area
where the injection is needed.
SURGERY
Surgery may be an option for the few patients whose symptoms do not go away despite other
treatments and time.
See also: Diskectomy
Ask your doctor which treatment options are best for you.

Outlook (Prognosis)

Most people will improve with conservative treatment. A small percentage may continue to have
chronic back pain even after treatment.
It may take several months to a year or more to resume all activities without pain or strain to the
back. People with certain occupations that involve heavy lifting or back strain may need to
change job activities to avoid recurrent back injury.

Possible Complications
• Long-term back pain
• Loss of movement or sensation in the legs or feet
• Loss of bowel and bladder function
• Permanent spinal cord injury (very rare)

When to Contact a Medical Professional

Call your health care provider if:

Safe work and play practices, proper lifting techniques, and weight control may help prevent
back injury in some people.
Some health care providers recommend the use of back braces to help support the spine. Such
braces can help prevent injuries in people whose work requires them to lift heavy objects.
However, overuse of these devices can weaken the abdominal and back muscles, making the
problem worse.

Alternative Names

Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed