Herniated disk

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.

Herniated nucleus pulposus (slipped disk)

Alternative Names

Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk; Herniated nucleus pulposus: Low back pain - herniated disk; LBP - herniated disk; Sciatica - herniated disk; Herniated disk

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 vertebra.

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 a 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 may include:

Symptoms

The pain most often occurs on one side of the body. Symptoms vary depending on the site of injury, and may include the following:

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 health care provider 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. Your bladder control may be lost.

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 provider examines your neck, shoulder, arms, and hands, or your lower back, hips, legs, and feet.

Your provider will check:

Your provider may also ask you to:

Leg pain that occurs when you sit 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 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

 Tests done may include: 

Treatment

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

MEDICINES

Medicines can help with your pain. Your provider may prescribe any of the following:

LIFESTYLE CHANGES

If you are overweight, diet and exercise are very important for improving back pain.

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 spinal nerve and disk and relieve many symptoms. They do not solve the underlying problem and your pain may return after weeks or months. Spinal injections are an outpatient procedure.

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 provider 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 provider if you have:

Prevention

To help prevent back injury:

Your provider may suggest a back brace to help support the spine. A brace may 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

Gardocki RJ, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 42.

Magee DJ. Lumbar spine. In: Magee DJ, ed. Orthopaedic Physical Assessment. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 9.

Safran MR, Zachazewski J, Stone DA. Herniated disk (ruptured disk). In: Safran MR, Zachazewski J, Stone DA, eds. Instructions for Sports Medicine Patients. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2012:462-470.


Review Date: 9/22/2016
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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