Herniated Disc

What is a herniated disc?

The spine, or backbone, is made up of a series of individual bones called vertebrae that are stacked to form the spinal column. Between the vertebrae are flat, round, cushioning pads called intervertebral discs, which act as shock absorbers. Each disc has a soft, gel-like center — called the nucleus pulposus — surrounded by a tough, fibrous outer layer called the annulus.

A herniated disc — also called a slipped disc or ruptured disc — occurs when pressure from the vertebrae above and below force some or all of the nucleus pulposus through a weakened or torn part of the annulus. The herniated nucleus pulposus can press on the nerves near the disc, resulting in pain.

Herniated discs usually occur in the lower part of the spine. A herniated disc is one of the most common causes of back and leg pain (sciatica). The discs in the neck are affected 8 percent of the time, and the upper-to-mid-back discs only 1 percent to 2 percent of the time.

What are the symptoms of a herniated disc?

Many herniated discs produce no symptoms at all. Symptoms of a herniated disc in the low back include:

• Pain that radiates to the buttocks, legs, and feet — called sciatica (Back pain might or might not be present, as well.)
• Tingling or numbness in the legs or feet
• Muscle weakness

Symptoms of a herniated disc in the neck include:

• Pain near or over the shoulder blade
• Pain that radiates to the shoulder, arm, and — sometimes — the hand and fingers
• Neck pain, especially in the back and on the sides of the neck (The pain might increase when bending or turning the neck.)
• Spasm of the neck muscles

Symptoms of a herniated disc in the mid-back tend to be vague. There might be pain in the upper back, lower back, abdomen, or legs, as well as weakness or numbness in one or both legs.

The pain associated with a herniated disc is generally worse when coughing, laughing, or straining.

What causes a herniated disc?

A herniation occurs when the outer part of the disc, the annulus, becomes weak and tears. Several factors can contribute to disc weakening, including

• Wear and tear of aging
• Excessive weight
• A sudden strain from improper lifting or from twisting violently

How common are herniated discs?

Herniated discs are very common. They occur more often in people ages 35 to 55 years. They are more common in men than in women.

How is a herniated disc diagnosed?

Your health care provider will begin an evaluation with a complete physical examination and medical history, including a review of your symptoms. He or she might perform a neurological exam to test your muscle reflexes, sensation, and muscle strength.

An important test in the diagnosis of a herniated disc is the straight leg-raising test. During this test, you lie on your back with your legs straight. The health care provider will slowly raise each leg and note the elevation at which your pain begins.

The health care provider might use certain other diagnostic tests to confirm the diagnosis and to better evaluate the site and extent of the herniation. These tests might include:

• X-ray — X-rays use small doses of radiation to produce images of the body. An X-ray of the spine might be done to rule out other causes of the back or neck pain.
• MRI or CT scan — Magnetic resonance imaging (MRI) and computed tomography (CT) scans can show narrowing of the spinal canal caused by a herniation.
• Myelogram — This is an injection of dye into the spinal canal followed by a CT scan. A myelogram can help pinpoint the size and location of the herniation.
• EMG — An electromyelogram (EMG) involves placing small needles into various muscles and measuring electrical activity. The muscle's response, which indicates the degree of nerve activity, is measured. An EMG can help determine which nerve root or roots are being affected by the disk herniation.

How is a herniated disc treated?

Most herniated discs respond to conservative treatment, which includes relative rest, medicine, and physical therapy. Some people find that ice packs or moist heat applied to the affected area provides some relief of the pain and muscle spasms in the back. In cases that do not improve with conservative treatment, spinal injections or surgery might be needed.

• Medicine — Pain medicines and non-steroidal anti-inflammatory drugs (NSAIDs) help to relieve pain, inflammation, and stiffness, allowing for increased mobility and exercise.

• Physical therapy — The goal of physical therapy is to improve strength, flexibility, and endurance to enable you to engage in your normal activities.

• Spinal injections — An injection of a cortisone-like medicine into the lower back might help reduce swelling and inflammation of the nerve roots, allowing for increased mobility. These injections are called epidurals or nerve blocks.
• Surgery — Surgery might be needed for people who do not respond to conservative treatment, whose symptoms get progressively worse, or who experience progressive weakness. Rarely, a large disc herniation might injure nerves to the bladder or bowel, which requires emergency surgery. Surgical options include laminectomy, spinal fusion, and microdiscectomy.
  • Laminectomy — The part of the bone that curves around and covers the spinal cord (lamina) and the tissue that is causing pressure on the nerve or spinal cord are removed. This procedure is performed under general anesthesia. The hospital stay is one to two days. Complete recovery takes about five weeks.
  • Spinal fusion — A spinal fusion might be necessary if instability between vertebrae is present. The surgery joins the vertebrae together using bone grafts. The lumbar vertebrae are repaired through an incision directly over the spine (posterior lumbar approach).
  • Microdiscectomy — Microdiscectomy is a procedure used to remove fragments of a herniated disc, often using an operating microscope.

What complications are associated with a herniated disc?

Chronic (ongoing) back or leg pain, loss of control or sensation in the legs or feet are some complications of an untreated disc herniation.

What is the outlook for people with herniated discs?

Most back and leg pain will get better gradually — usually in four to six weeks — by taking simple measures. In fact, most people with herniated discs respond to conservative treatment within six weeks and are able to return to their normal activities. Some will continue to have back pain even after treatment.

Can anything be done to prevent a herniated disc?

It is not always possible to prevent a herniated disc, but there are steps you can take to reduce your risk:

• Use proper lifting techniques. Do not bend at the waist. Bend your knees and use your strong leg muscles to help you support the load.
• Maintain a healthy weight. Excess weight puts pressure on the lower back.
• Practice good posture when walking, sitting, standing, and sleeping. For example, stand up straight with your shoulders back, abdomen in, and the small of your back flat. Sit with your feet flat on the floor or elevated. Sleep on a firm mattress, and sleep on your side, not your stomach.
• Stretch often when sitting for long periods of time.
• Do not wear high-heeled shoes.
• Exercise regularly to keep the muscles of your back, legs, and stomach strong. Engage in regular aerobic exercise. Try to balance flexibility with strengthening in a regular exercise program.
• Stop smoking.
• Eat healthy, well-balanced meals

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/20/2006…#12768