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Herniated disk

Herniated disk repair
Lumbar spinal surgery - Series

Definition

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

Alternative Names

Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk; Herniated nucleus pulposus

Causes

The bones (vertebrae) of the spinal column protect nerves that come out of the brain and travel down your back to form 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 bones are separated by disks. These disks cushion the spinal column and put space between your vertebrae. The disks allow movement between the vertebrae, which lets you bend and reach.

With herniated disk:

A herniated disk is one cause of radiculopathy. This is any disease that affects the spinal nerve roots.

Slipped disks occur more often in middle-aged and older men, usually after strenuous activity. Other risk factors include conditions present at birth (congenital) that affect the size of the lumbar spinal canal.

Symptoms

The pain most often occurs on one side of the body.

The pain often starts slowly. It may get worse:

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 goes away or improves a lot over weeks to months.

Exams and Tests

A careful physical exam and history is almost always the first step. Depending on where you have symptoms, your doctor examines your neck, shoulder, arms, and hands, or your lower back, hips, legs, and feet.

Your doctor will check:

Your doctor may also ask you to:

Leg pain that occurs when you sit down on an exam table and lift your leg straight up usually suggests a slipped disk in your lower back.

In another 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 pressure on a nerve in your neck.

DIAGNOSTIC TESTS

Treatment

The first treatment for a slipped disk is a short period of rest with medicines for the pain. This is followed by physical therapy. Most people who follow these treatments recover and return to normal activities. Some persons will need to have more treatment. This may include steroid injections or surgery.

MEDICATIONS

Medicines can help with your pain. Your doctor may prescribe nonsteroidal anti-inflammatory medications (NSAIDs for long-term pain control. Narcotics may be prescribed if the pain is severe and does not respond to NSAIDs.

If you have back spasms, you will usually receive muscle relaxants. In rare cases, steroid medicines may be given, either by pill or  through a vein (IV), to control your back pain.

LIFESTYLE CHANGES

Diet and exercise are very important for improving back pain if you are overweight.

Physical therapy is important for nearly everyone with disk disease. Therapists will teach you how to properly lift, dress, walk, and perform other activities. They teach you how to strengthen muscles that help support the spine. You will also learn how to increase flexibility in your spine and legs.

Take care of your back at home:

INJECTIONS

Steroid medicine injections into the back in the area of the herniated disk may help control pain for several months. These injections reduce swelling around the disk and relieve many symptoms. Spinal injections are usually done in your doctor's office.

SURGERY

Surgery may be an option if your symptoms do not go away with other treatments and time.

Diskectomy is surgery to remove all or part of a disk.

Discuss with your doctor which treatment options are best for you.

Outlook (Prognosis)

Most people improve with treatment. But you may have long-term back pain even after treatment.

It may take several months to a year or more to go back to all of your activities without having pain or straining your back. People who work in jobs that involve heavy lifting or back strain may need to change their job activities to avoid injuring their back again.

Possible Complications

In rare cases, the following problems can occur:

When to Contact a Medical Professional

Call your health care provider if:

Prevention

Being safe at work and play, using proper lifting techniques, and controlling weight may help prevent back injury.

Your health care provider may recommend a back brace to help support the spine. A brace can help prevent injuries in people who lift heavy objects at work. But using these devices too much can weaken the muscles that support your spine and make the problem worse.

References

Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010;41:217-224.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078-93. Review.


Review Date: 4/16/2013
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.