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HERNIATED NUCLEUS PULPOSUSDEFINITION
A herniated nucleus pulposus is a slipped disk along the spinal cord. Thecondition occurs when all or part of the soft center of a spinal disk is forced through aweakened part of the disk.
ALTERNATIVE NAMES
Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk;Prolapsed intervertebral disk; Slipped disk; Ruptured disk
INCIDENT RATE
Most herniation takes place in the lower back (lumbar area) of the spine. Lumbar disk herniation occurs 15 times more often than cervical (neck) disk herniation, and it isone of the most common causes of lower back pain. The cervical disks are affected 8%of the time and the upper-to-mid-back (thoracic) disks only 1 - 2% of the time.Nerve roots (large nerves that branch out from the spinal cord) may becomecompressed resulting in neurological symptoms, such as sensory or motor changes.Disk herniation occurs more frequently in middle aged and older men, especiallythose involved in strenuous physical activity. Other risk factors include any congenitalconditions that affect the size of the lumbar spinal canal.
RISK/PREDISPOSING FACTORS
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Strenuous physical activity
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Congenital conditions that affect the size of the lumbar spinal canal.
MANIFESTATION
SYMPTOMS OF HERNIATED LUMBAR DISK 
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Muscle spasm
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Muscle weaknessor atrophy in later stages
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Pain radiating to the buttocks, legs, and feet
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Pain made worse with coughing, straining, or laughing
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Severelow back pain
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Tinglingor numbnessin legs or feet
 
SYMPTOMS OF HERNIATED CERVICAL DISK 
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Arm muscle weakness
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Deep pain near or over the shoulder blades on the affected side
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Neck pain, especially in the back and sides
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Increased pain when bending the neck or turning head to the side
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Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
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Pain made worse with coughing, straining, or laughing
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Spasm of the neck muscles
TYPE/STAGE/CLASSIFICATION
Person who has sustained one disc herniation is statistically at increased risk for experiencing another. There is an approximate 5% rate of recurrent disc herniation atthe same level, and a lesser incidence of new disc herniation at another level. Factorsinvolved may be weight related level of physical conditioning, work or behavioral habits.Since these factors are typically the same after surgery, there is an increased risk of herniated disc in this group, over the general population.However, the good news is that the majority of disc herniations (90%) do notrequire surgery, and will resolve with conservative, nonoperative treatment, withoutsignificant long-term sequelae. Unfortunately, approximately 5% of patients withherniated, degenerated discs will go on to experience symptomatic or severe andincapacitating low back pain which significantly affects their life activities and work. Thisunfortunate result is not always specifically the result of surgery. The causes of thisunremitting pain are not always clear or agreed on, and my be from several sources.When this occurs, the prognosis is poor for returning to normal life activities regardlessof age.After a successful laminotomy and discectomy, 80-85% of patients do extremelywell and are able to return to their normal job in approximately six weeks time. Theremay be small permanent patches of numbness in the involved leg which, fortunately,are not disabling. Flare-ups or exacerbations of less severe and less significant sciatictype pain may develop in the future (usually on an infrequent basis).
 
Impairedmobility
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