A herniated disk (or disc) happens when one of the disks in the spine bulges from its proper place. Disks are small circular cushions between the vertebrae (bones) in the spine. The disks are compressible and act as cushions for the bones of the spine. Herniated disks press on the nerves where they exit from the spinal column in close proximity to the disk and can cause severe pain. This is most common in the lower spine.
Causes
Herniated disks can occur when disks dry out, 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
A risk factor is something that increases your chance of getting a disease or condition.
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Age: 30s and 40s
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Trauma from a fall, accident, or sudden twisting
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Strain on the back – either repeated or sudden (as from lifting a heavy weight)
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Certain jobs requiring heavy lifting
Symptoms
Symptoms include:
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Pain – The severity and location of the pain depend upon which disk is herniated and how large the herniation is.
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Numbness, tingling, or weakness in the legs or feet
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Bowel or bladder changes
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In severe cases, inability to find comfort even lying down
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Sudden aching or twisted neck that cannot be straightened without severe pain
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Numbness, tingling, or weakness in one or both arms
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. You will also be asked specific questions about the pain and examine the spine. 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 disk to be seen
Diskography – a test that involves injecting a dye into the center of the disk and then taking an x-ray, which may show the dye leaking out
Electromyography – a test that measures the electrical activity of muscle by placing needle electrodes into the muscle (This can indicate whether the nerve signal to the muscle is firing normally.)
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, the nerves, and show any disk herniation
Treatment
Treatments may include:
NSAIDs
Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen, may be prescribed to reduce pain.
Muscle Relaxants
Muscle relaxants may be prescribed to reduce muscle spasms.
Analgesics
Various types of analgesic medications may be prescribed, depending on the level of pain.
Steroid Injections
If medicine doesn't help, steroids may be injected into the area around the nerve and disk herniation backbone to reduce pain and inflammation.
Bedrest
Bedrest for one or two days is often suggested for severe pain. You should lie on a firm mattress with your knees and hips partially bent. Your lower legs may be elevated on pillows or a wedge.
Back or Neck Massage and Physical Therapy
Back or neck massage and physical therapy can help:
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Relax the neck or back muscles
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Decrease pain
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Increase strength and mobility
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After the acute phase, there are certain back and abdominal exercises that can help the recovery phase and prevent recurrences.
Hot or Cold Packs
Hot or cold packs help reduce pain and muscle spasms.
Stretching the Spine
A doctor or chiropractor can sometimes help reduce pain by stretching your spine. Any spinal manipulation for a chronic disk problem must be done very carefully and only by an experienced, licensed practitioner.
Traction
Weights and pulleys may be used to relieve pressure on the disks and keep the patient from moving around; this is more common for disks in the neck area.
Neck Collar or Brace
For a herniated disk in the neck, a neck collar or brace may be used to relieve muscle spasms.
Surgery
Surgery may be used for people who fail to respond to other treatments. Options include:
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Laminectomy – removal of some of the bone overlying the spinal canal and of the protruding disk under that
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Micro Diskectomy – removal of fragments of herniated disk through a smaller incision without doing a laminectomy
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Spinal Fusion – fusing of vertebrae (back bones) together with bone grafts or metal rods (rarely done for first-time disk problems)
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Chemonucleolysis – injection of an enzyme into the herniated disk to dissolve the protruding part
Prevention
The following strategies may help you reduce your chance of having a herniated disk:
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Practice good posture—standing and sitting straight, keeping your back straight when lifting.
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Maintain a healthy weight.
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Exercise regularly. Ask your doctor about exercises to strengthen your back and stomach.
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Don't wear high-heeled shoes.
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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/default.asp
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html.
American College of Physicians Complete Home Medical Guide. DK Publishing; 1999.
