A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine.
A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer "jelly" pushes out through a tear in the tougher exterior.
A herniated disk can press on the nerves in your spine and cause pain, weakness, and numbness in your neck, back, arms, and legs. Sometimes these symptoms can be severe enough to disrupt your life.
A herniated disc can occur anywhere in the spine. The two most common locations are the lumbar spine and the cervical spine. The lumbar spine refers to the lower back, while the cervical spine refers to the neck region.
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Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.
Most people can't pinpoint the exact cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, 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 can cause a herniated disk.
Certain individuals may be more vulnerable to disc problems and, as a result, may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families with several members affected.
Most herniated disks occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine). The most common signs and symptoms of a herniated disk are:
. Arm or leg pain. If your herniated disk is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
. Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.
. Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
You also can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem.
When to see a doctor
Seek medical attention if your neck or back pain travels down your arm or leg, or if you also have numbness, tingling or weakness.
Factors increasing your risk of a herniated disk may include:
. Weight. Excess body weight causes extra stress on the disks in your lower back.
. Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disk.
. Genetics. Some people inherit a predisposition to developing a herniated disk.
. Unsafe lifting technique. People should always apply force from the legs, not the back, when lifting heavy items. Incorrect technique can lead to a herniated disk.
. Driving often. A combination of being seated for long periods and the vibrations and movements of the car can damage the disks and spinal structure.
. Sedentary lifestyle. A lack of exercise can lead to a herniated disk.
. Smoking. This might reduce oxygen supply to the disks and lead to a grinding-down of the tissue.
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Your spinal cord doesn't extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse's tail. Rarely, disk herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.
Seek emergency medical attention if you have:
. Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.
. Bladder or bowel dysfunction. People who have cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
. Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.
Discectomies hardly ever result in complications. However, in rare cases, people may experience the following:
. Tears in the spine’s protective lining
. Injury to the nerve
In around 5% of people, the problematic disc may rupture again, causing symptoms to recur.
Herniated disc surgery can be an effective treatment for many people with challenging pain. However, surgeons cannot guarantee that symptoms will disappear after surgery.
Some people may continue to experience herniated disc pain after the recovery period. In some cases, the pain may worsen over time.
To help prevent a herniated disk:
. Exercise. Strengthening the trunk muscles helps stabilize and support the spine.
. Maintain good posture. Good posture reduces the pressure on your spine and disks. Keep your back straight and aligned, particularly when sitting for long periods. Lift heavy objects properly, making your legs — not your back — do most of the work.
. Maintain a healthy weight. Excess weight puts more pressure on the spine and disks, making them more susceptible to herniation.
. Quit smoking. Avoid the use of any tobacco products.
During the physical exam, your doctor will check your back for tenderness. He or she may ask you to lie flat and move your legs into various positions to help determine the cause of your pain. Your doctor may also perform a neurological exam, to check your:
. Muscle strength
. Walking ability
. Ability to feel light touches, pinpricks or vibration
In most cases of herniated disk, a physical exam and a medical history are all that's needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.
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. X-rays. Plain X-rays don't detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
. Computerized tomography (CT scan). A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.
. Magnetic resonance imaging (MRI). Radio waves and a strong magnetic field are used to create images of your body's internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.
. Myelogram. A dye is injected into the spinal fluid, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.
. Nerve conduction study. This test measures electrical nerve impulses and functioning in your muscles and nerves through electrodes placed on your skin. The study measures the electrical impulses in your nerve signals when a small current passes through the nerve.
. Electromyography (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest.
The initial treatment for a herniated disc is usually conservative and nonsurgical. A doctor may advise the patient to maintain a low, painless activity level for a few days to several weeks. This helps the spinal nerve inflammation to decrease. Bedrest is not recommended.
A herniated disc is frequently treated with nonsteroidal anti-inflammatory medication, if the pain is only mild to moderate. An epidural steroid injection may be performed utilizing a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation.
The doctor may recommend physical therapy. The therapist will perform an in-depth evaluation, which, combined with the doctor's diagnosis, dictates a treatment specifically designed for patients with herniated discs. Therapy may include pelvic traction, gentle massage, ice and heat therapy, ultrasound, electrical muscle stimulation and stretching exercises. Pain medication and muscle relaxants may also be beneficial in conjunction with physical therapy.
. 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.
Most people with a herniated disk don't need surgery. Rest and other treatments should start to improve your symptoms within 4 to 6 weeks. But if your pain doesn’t improve, surgery might be an option.
Talk to your doctor about surgery if:
. You’re not getting relief from pain relievers, injections, and physical therapy.
. Your symptoms keep getting worse.
. You have trouble standing or walking.
. You can't control your bowels or bladder.
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After gathering all the information they can, your surgeon may recommend one of these surgeries. In some cases, a person may require a combination of surgeries.
. Diskectomy. During this procedure, your surgeon removes your damaged disk to relieve pressure on your nerves. He can perform the surgery in a couple of ways:
. Your surgeons performs open diskectomy is via a cut in your back or neck.
. Microdiscectomy is done through a much smaller incision. Your surgeon inserts a thin tube with a camera on one end to see and remove the damaged disk.
. Lumbar laminotomy. Sometimes your surgeon will also need to remove a small piece of bone called the lamina from the vertebra. The lamina forms a protective cover over your spinal cord. Removing part or all of it helps the surgeon access your herniated disk. It also can relieve pressure on your nerves and eliminate leg pain and sciatica.
The lamina can be removed during the diskectomy. Or, you might have it taken out in a separate surgery.
. Spinal fusion. After a diskectomy or laminotomy, your surgeon may fuse together the two vertebrae on either side of the disk to stabilize your spine. This is called spinal fusion. Fusing the two disks will stop the bones from moving and prevent you from having any more pain.
. Artificial disk surgery. Only a few people are good candidates for artificial disk surgery because it only works on certain disks in your lower back. But if your doctor thinks this is an option, he will replace your damaged disk with one made of plastic or metal. The new disk will help keep your spine stable and let you move more easily.
After Herniated Disk Surgery
Recovery process and timeline
According to the North American Spine Society, people who undergo surgery for a herniated disc earlier rather than later may have a faster recovery time. They may also experience improved long term health.
Typically, most people can go home 24 hours after a herniated disc operation. Some may even be able to go home the same day.
Doctors recommend that people recovering from herniated disc surgery avoid the following activities for around 4 weeks:
. Sitting for long periods
. Lifting heavy weights
. Bending over
Some exercises may be beneficial for people who have had herniated disc surgery. However, they should consult their doctor or surgeon before attempting any strenuous activities.
Sometimes, doctors may suggest rehabilitation therapy after surgery. People who follow a rehabilitation program after herniated disc surgery may achieve a shorter recovery time and improved mobility.
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Lifestyle and home remedies
Besides taking the pain medications your doctor recommends, try:
. Applying heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you might switch to gentle heat to give relief and comfort.
. Avoiding too much bed rest. Staying in bed can lead to stiff joints and weak muscles — which can complicate your recovery. Instead, rest in a position of comfort for 30 minutes, and then go for a short walk or do some work. Try to avoid activities that worsen your pain.
. Resuming activity slowly. Let your pain guide you in resuming your activities. Make sure your movements are slow and controlled, especially bending forward and lifting.
Some alternative and complementary medicine treatments might help ease chronic back pain. Examples include:
. Chiropractic. Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.
. Acupuncture. Although results are usually modest, acupuncture appears to ease chronic back and neck pain.
. Massage. This hands-on therapy can provide short-term relief to people dealing with chronic low back pain.