HERNIATED DISC

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A herniated disk refers to a problem with one of the rubbery cushions (disks) that sit between the individual bones (vertebrae) that stack to make your spine.

A spinal disk has a soft, jellylike center (nucleus) encased in a tougher, rubbery exterior (annulus). Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the nucleus pushes out through a tear in the annulus.

A herniated disk, which can occur in any part of the spine, can irritate a nearby nerve. Depending on where the herniated disk is, it can result in pain, numbness or weakness in an arm or leg.

Many people have no symptoms from a herniated disk. Surgery is usually not necessary to relieve the problem.

SPINAL DISC ANATOMY

DISEASE EXPLAINED

SYMPTOMS

Most herniated disks occur in the lower back, although they can also occur in the neck. Signs and symptoms depend on where the disk is situated and whether the disk is pressing on a nerve. They usually affect one side of the body.

ARM OR LEG PAIN.
If your herniated disk is in your lower back, you'll typically feel the most pain in your buttocks, thigh and calf. You might have pain in part of the foot, as well. If your herniated disk is in your neck, you'll typically feel the most pain in your shoulder and arm. This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions. Pain is often described as sharp or burning.

NUMBNESS OR TINGLING.
People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves.

WEAKNESS.
Muscles served by the affected nerves tend to weaken. This can cause you to stumble, or affect your ability to lift or hold items.

You can have a herniated disk without symptoms. You might not know you have it unless it shows up on a spinal image.

CAUSES

Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your disks become less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Most people can't pinpoint the cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back is the cause.

TREATMENT

TREATMENT OPTIONS

Conservative treatment — mainly modifying activities to avoid movement that causes pain and taking pain medication — relieves symptoms in most people within a few days or weeks.

MEDICATIONS
Over-the-counter pain medications. If your pain is mild to moderate, your doctor might recommend over-the-counter pain medication, such as acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).

CORTISONE INJECTIONS.
If your pain doesn't improve with oral medications, your doctor might recommend a corticosteroid that can be injected into the area around the spinal nerves. Spinal imaging can help guide the needle.

MUSCLE RELAXERS.
You might be prescribed these if you have muscle spasms. Sedation and dizziness are common side effects.

OPIOIDS.
Because of the side effects of opioids and the potential for addiction, many doctors hesitate to prescribe them for disk herniation. If other medication doesn't relieve your pain, your doctor might consider short-term use of opioids, such as codeine or an oxycodone-acetaminophen combination (Percocet, Roxicet). Sedation, nausea, confusion and constipation are possible side effects from these drugs.

THERAPY
Your doctor might suggest physical therapy to help with your pain. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.

SURGERY
Few people with herniated disks eventually need surgery. Your doctor might suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to have:

Poorly controlled pain

Numbness or weakness

Difficulty standing or walking

Loss of bladder or bowel control

In nearly all cases, surgeons can remove just the protruding portion of the disk. Rarely, the entire disk must be removed. In these cases, the vertebrae may need to be fused with a bone graft.

To allow the process of bone fusion, which takes months, metal hardware is placed in the spine to provide spinal stability. Rarely, your surgeon might suggest the implantation of an artificial disk.

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