Herniated Disk

When people say they have a "slipped" or "ruptured" disk in their neck or lower back, what they are actually describing is a herniated disk-a common source of pain in the neck, lower back, arms, or legs. Anatomy Disks are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the back to flex or bend. Disks also act as shock absorbers. Normal anatomy of lumbar spine. 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. Top of page Cause

A herniated disk (side view and cross-section). A disk herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs. Top of page Risk Factors/Prevention In children and young adults, disks have high water content. As people age, the water content in the disks decreases and the disks become less flexible. The disks begin to shrink and the spaces between the vertebrae get narrower. Conditions that can weaken the disk include: • Improper lifting • Smoking • Excessive body weight that places added stress on the disks (in the lower back) • Sudden pressure (which may be slight) • Repetitive strenuous activities Top of page Symptoms Lower Back Low back pain affects four out of five people. Pain alone is not enough to recognize a herniated disk. See your doctor if back pain results from a fall or a

blow to your back. • After any spasms settle. Tell the doctor if you were injured. Any physical activity should be slow and controlled. analgesics. you could have a serious problem and should seek immediate attention. MRI (magnetic resonance imaging) or CT (computed tomography) (imaging tests to confirm which disk is injured) or electromyography (a test that measures nerve impulses to the muscles) may be recommended if the pain continues. gentle heat applications may be used. The most common symptom of a herniated disk is sciatica—a sharp. A physical examination will help determine which nerve roots are affected (and how seriously). often shooting pain that extends from the buttocks down the back of one leg. Tell him or her if you have neck/back pain with gradually increasing arm/leg pain. Most neck or back pain will resolve gradually with simple measures. and anti-inflammatory medications are also helpful.) • A burning pain centered in the neck Neck As with pain in the lower back. or arm Top of page Diagnosis To diagnose a herniated disk. • Rest and over-the-counter pain relievers may be all that is needed. When pressure is placed on a nerve in the neck. The pain may shoot down the arm. It is caused by pressure on the spinal nerve. neck pain is also common. The pain may also cause headaches in the back of the head. especially bending forward . it causes pain in the muscles between your neck and shoulder (trapezius muscles). • Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time. • Muscle relaxers. your doctor will ask for your complete medical history. you could have a serious problem and should seek immediate attention.) • Burning pain in the shoulders. Other symptoms include: • 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. Top of page Treatment Nonsurgical Treatment Nonsurgical treatment is effective in treating the symptoms of herniated disks in more than 90% of patients. neck. 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. A simple X-ray may show evidence of disk or degenerative spine changes.

In the neck. Learn more about disc herniation: Causes of Herniated Discs Herniated Discs vs. Editorial Board & Staff | Contributors Online Linking Advertising & | Agreements | Policy | Sponsorship | Privacy AAOS Policy | News Bureau Copyright ©1995-2010 by the American Academy of Orthopaedic Surgeons. and lift. Top of page Last reviewed and updated: July 2007 AAOS does not review or endorse accuracy or effectiveness of materials. exercises may also be helpful in strengthening the back and abdominal muscles.and lifting. You should be able to return to work in 2 to 6 weeks after surgery. depending on the size and position of the disk herniation. All rights reserved. epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. This website also contains material copyrighted by third parties. causing significant loss of function. To help avoid future episodes of pain. Each of these surgical procedures is performed with the patient under general anesthesia. treatments or physicians. All material on this website is protected by copyright. an anterior cervical diskectomy and fusion are usually recommended. it is essential that you learn how to properly stand. sit. These injections are given on an outpatient basis over a period of weeks. Bulging Discs Symptoms of Herniated Discs Treatment for Herniated Discs Causes of Herniated Discs . Surgical options in the lower back include microdiskectomy or laminectomy. This involves removing the entire disk to take the pressure off the spinal cord and nerve roots. exercises or traction may also be helpful. For the lower back. For some patients. If these nonsurgical treatment measures fail. a smaller surgery may be performed on the back of the neck that does not require fusing the bones together. SurgicalTreatment Surgery may be required if a disk fragment lodges in the spinal canal and presses on a nerve. They may be performed on an outpatient basis or require an overnight hospital stay. Bone is placed in the disk space and a metal plate may be used to stabilize the spine. For the neck.

Bulging Discs vs. which means the nucleus pulposus remains contained within the annulus fibrosus. are the “building blocks” of the spine. These discs may bulge or herniate from trauma or strain. Nerve roots (large nerves that branch out from the spinal cord) may become compressed by herniated discs that narrow the space through which the nerve roots travel. The disc remains intact except a small bubble appears on the outside of the disc.Disc herniation occurs more frequently in middle-aged and older persons. sometimes fragments from the annulus (the outer disc wall) may break away from the parent disc and drift into the spinal canal. Lumbar disc herniation occurs 15 times more often than cervical (neck) disc herniation. providing protection for the spinal cord from skull to the pelvis. Non-Contained Disc Disorders A contained disc — such as a bulging disc — has not broken through the outer wall of the intervertebral disc. A bulging disc may be a precursor to a herniation. The bones of the spinal column. These bones also protect nerve roots as they exit the spinal cord and travel to various parts of the body. It may also be cuased by trauma of some sort such as a car accident or lifting something heavy. The gel-like interior (nucleus pulposus) does not leak out. When a disc herniates. and it is one of the most common causes of lower back pain. A non-contained disc — such as a herniated or ruptured disc — has either partially or completely broken through the outer wall of the intervertebral disc. or vertebrae. Herniated Discs The primary difference between bulging discs and herniated discs are whether they are contained or non-contained: Contained vs. Herniated Discs Symptoms Cervical Herniated Disc Symptoms • Arm muscle weakness . Most herniation takes place in the lumbar area of the spine. which provides cushioning to the spinal column. Other risk factors may include a number of congenital conditions. especially if degenerative changes have occurred in the disc. To complicate matters. especially those involved in strenuous physical activity. The spinal vertebrae are separated by intervertebral discs filled with a gelatinous substance. The disc may protrude into the spinal canal without breaking through the disc wall. the contents may compress the spinal cord or the spinal nerve roots.

straining or laughing Pain radiating to the shoulder. and rarely the hand. fingers or chest • Spasm of the neck muscles Lumbar Herniated Disc Symptoms • Muscle spasm • Muscle weakness or atrophy in later stages • Pain made worse with coughing. legs. straining or laughing • Pain radiating to the buttocks. and feet • Severe low-back pain • Tingling or numbness in legs or feet . especially in the back and sides Pain made worse with coughing.• • • • • Deep pain near or over the shoulder blades on the affected side Increased pain when bending the neck or turning head to the side Neck pain. forearm. upper arm.

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