What is a Herniated Disk

Anatomy of the spine:

You've probably heard people say they have a "slipped" or "ruptured" disk in their neck or lower back. Actually, they are referring to a herniated disk, a common source of neck, or lower back and arm or leg pain.

Disks are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. They act as shock absorbers. In the middle of the spinal column is the spinal canal-a hollow space that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the back to flex or bend.

Disks in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the disks are similar but smaller in size. Think of a jelly donut that has a thick outer portion (annulus) and the jelly is the nucleus.

A disk herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk. To continue with the donut analogy, the jelly pushes backwards toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure. Pain, numbness or weakness may occur in one or both legs.

Risk Factors:

In children and young adults, disks have high water content. As you get older, the water content in the disks decreases, they become less flexible, and the disks begin to shrink. The spaces between the vertebrae get narrower. The disk itself becomes less flexible.

Conditions that can weaken the disk include:

Improper lifting of heavy boxes, furniture, equipment
Smoking
Excessive body weight that places added stress on the disks (in the lower back)
Sudden pressure (which may be slight)
Repetitive strenuous activities

Symptoms of a Herniated Disk:

Lower Back: Low back pain affects four out of five people. Pain alone isn't enough to recognize a herniated disk. See your orthopedist if back pain is a result from a fall or a blow to your back.

The most common symptom of a herniated disk is sciatica-a sharp, often shooting pain that extends from the buttocks down the back of one leg. It is caused by pressure on the spinal nerve.

Other symptoms of a herniated disc include:

Low Back Pain
Sciatica – “shooting” pain that extends from the buttocks down the back of one leg
Weakness in one leg
Tingling (a "pins-and-needles" sensation) or numbness in one leg or buttock
Loss of bladder or bowel control (If you also have significant weakness in both legs, you could have a serious problem. Seek immediate attention.)
A burning pain centered in the neck

Neck: Like pain in the lower back, neck pain is also very common. When pressure is placed on a nerve in the neck, it causes pain in the muscles between your neck and shoulder (trapezial muscles). The pain may shoot down the arm. Sometimes the pain causes headaches in the back of the head.

Other symptoms include:

Weakness in one arm
Tingling (a "pins-and-needles" sensation) or numbness in one arm
Loss of bladder or bowel control (If you also have significant weakness in both arms or legs, you could have a serious problem. Seek immediate attention.)
Burning pain in the shoulders, neck or arm
Neck pain – often shooting down the arm
Headaches in the back of the head

How to Diagnosis a Herniated Disk?

Give the doctor your complete medical history.
Tell him or her if you have neck/back pain with gradually increasing arm/leg pain.
Tell the doctor if you were injured.
The doctor will physically examine you. This can determine which nerve roots are affected (and how seriously).
X-rays may show evidence of disk or degenerative spine changes.
MRI (magnetic resonance imaging) will confirm which disk is injured
CT (computed tomography)
EMG is a test that measures nerve impulses to the muscles, may be recommended if pain continues.

Treatment Options: Non- Surgical

Conservative treatment is effective in treating symptoms of herniated disks in more than 90 percent of patients. Most neck or back pain will resolve gradually with simple measures.

Bed rest
Over-the-counter pain relievers –reduce pain and inflammation, i.e. Ibuprofen, Naproxen
Muscle relaxers, analgesic and anti-inflammatory medications are helpful to relieve pain and inflammation
Apply cold compresses or ice for no more than 20 minutes at a time, several times a day. Then switch to gentle heat applications after spasms settle.
Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return. Take short walks and avoid sitting for long periods. For the lower back, exercises may also be helpful in strengthening back and abdominal muscles. For the neck, exercises or traction may also be helpful. It's essential that you learn how to properly stand, sit and lift. This can help you avoid future episodes of pain.

Treatment Options: Surgical

If conservative treatment does not effectively relieve the pain, epidural injections with cortisone (i.e. depo medrol or Kenalog) may lessen nerve irritation and allow better participation in physical therapy. These shots are given on an outpatient basis over a period of a few weeks.

Surgery may be required if a disk fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function.

Surgical options in the lower back include microdiskectomy or laminectomy depending on the size and position of the disk herniation. In the neck, an anterior cervical discectomy and fusion is usually recommended. This involves removing the entire disk to take the pressure off the spinal cord and nerve roots. Bone is placed in the disc space and a metal plate may be used to stabilize the spine. On occasion, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together. Each of these surgeries is performed under general anesthesia. It may be performed as an outpatient or require an overnight hospital stay. You should be able to return to work in two to six weeks.