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Overview
A herniated disc occurs when the gel-like center of
a spinal disc ruptures through a weak area in the
tough outer wall, similar to the filling being
squeezed out of a jelly doughnut. Back or leg pain,
numbness or tingling may result when the disc
material touches or compresses a spinal nerve.
Treatment with rest, pain medication, spinal
injections, and physical therapy is the first step to
recovery. Most people improve in 6 weeks and
return to normal activity. If symptoms continue,
surgery to remove a portion of the disc and any
bone spurs may be recommended.
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Most herniated discs occur in the lumbar section of
the spine, where nerves from the spinal cord exit
between the lumbar vertebrae, and then join
together again to form the sciatic nerve, which runs
down your leg.
Who is affected? habits are causing the pain. Next a physical exam is
Herniated discs are most common in people in their performed to determine the source of the pain and
30s and 40s, although middle aged and older test for any muscle weakness or numbness.
people are slightly more at risk if they're involved in
strenuous physical activity. Your doctor may order one or more of the following
imaging studies: X-ray, MRI scan, myelogram, CT
Lumbar disc herniation is one of the most common scan, or EMG. Based on the results, you may be
causes of lower back pain associated with leg pain, referred to a neurologist, orthopedist, or
and occurs 15 times more often than cervical neurosurgeon for treatment.
(neck) disc herniation. Disc herniation occurs 8% of
the time in the cervical (neck) region and only 1 to • Magnetic Resonance Imaging (MRI) scan is
2% of the time in the upper-to-mid-back (thoracic) a noninvasive test that uses a magnetic field
region [1]. and radiofrequency waves to give a detailed
view of the soft tissues of your spine. Unlike an
How is a diagnosis made? X-ray, nerves and discs are clearly visible (Fig.
When you first experience pain, consult your family 2). It allows your doctor to view your spine 3-
dimensionally in slices, as if it were sliced layer-
doctor. Your doctor will take a complete medical
by-layer like a loaf of bread with a picture taken
history to understand your symptoms, any prior
injuries or conditions, and determine if any lifestyle of each slice. The pictures can be taken from
the side or from the top as a cross-section. It
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may or may not be performed with a dye Medication: Your doctor may prescribe pain
(contrast agent) injected into your bloodstream. relievers, nonsteroidal anti-inflammatory
An MRI can detect which disc is damaged and if medications (NSAIDs), muscle relaxants, and
there is any nerve compression. It can also steroids.
detect bony overgrowth, tumors, or abscesses. • Nonsteroidal anti-inflammatory drugs
• Myelogram is a specialized X-ray where dye is (NSAIDs), such as aspirin, naproxen (Alleve,
injected into the spinal canal through a spinal Naprosyn), ibuprofen (Motrin, Nuprin, Advil),
tap. An X-ray fluoroscope then records the and celecoxib (Celebrex), are used to reduce
images formed by the dye. Myelograms can inflammation and relieve pain.
show a nerve being pinched by a herniated disc, • Analgesics, such as acetaminophen (Tylenol),
bony overgrowth, spinal cord tumors, and can relieve pain but don’t have the anti-
abscesses. Regular X-rays of the spine only give inflammatory effects of NSAIDs. Long-term use
a clear picture of bones. The dye used in a of analgesics and NSAIDs may cause stomach
myelogram shows up white on the X-ray, ulcers as well as kidney and liver problems.
allowing the physician to view the spinal cord • Muscle relaxants, such as methocarbamol
and canal in detail. A CT scan may follow this (Robaxin), carisoprodol (Soma) and
test. cyclobenzaprine (Flexeril), may be prescribed to
• Computed Tomography (CT) scan is a safe, control muscle spasms.
noninvasive test that uses an X-ray beam and • Steroids may be prescribed to reduce the
a computer to make 2 dimensional images of swelling and inflammation of the nerves. They
your spine. Similar to an MRI, it allows your are taken orally (as a Medrol dose pack) in a
doctor to view your spine in slices, as if it were tapering dosage over a five-day period. It has
sliced layer-by-layer with a picture taken of the advantage of providing almost immediate
each slice. It may or may not be performed pain relief within a 24-hour period.
with a dye (contrast agent) injected into your • Steroid injections into the area of your
bloodstream. This test is especially useful for herniated disc may be prescribed if your pain
confirming which disc is damaged. is severe (see Epidural Steroid Injections).
• Electromyography (EMG) & Nerve This procedure, performed under fluoroscopy,
Conduction Velocity (NCV) tests. EMG involves an injection of steroids and an
measures your muscle response to electrical analgesic-numbing agent into the epidural
stimulation. Small needles are placed in your space of the spine to reduce the swelling and
muscles, and the results are recorded on a inflammation of the nerves. About 50% of
special machine. NCV is similar, but it measures patients will notice relief after an epidural
how well your nerves pass an electrical signal injection, although the results tend to be
from one end to another. These tests can detect temporary. Repeat injections, at 2-week
nerve damage and muscle weakness. intervals, may be necessary to obtain the best
• X-ray tests use X-rays to view the bony results in the shortest time. If the injection is
vertebrae in your spine and can tell your doctor helpful, it can be done up to three times a year.
if any of them are too close together or whether
you have arthritic changes, bone spurs, or Physical therapy: The goal of physical therapy is
fractures. It’s not possible to diagnose a to help you return to full activity as soon as
herniated disc with this test alone. possible and prevent re-injury. Physical therapists
can instruct you on proper posture, lifting, and
What treatments are available? walking techniques, and they’ll work with you to
Conservative nonsurgical treatment is the first step strengthen your lower back, leg, and stomach
to recovery and may include medication, rest, muscles. They’ll also encourage you to stretch and
physical therapy, home exercises, hydrotherapy, increase the flexibility of your spine and legs.
epidural steroid injections (ESI), chiropractic Exercise and strengthening exercises are key
manipulation, and pain management. With a team elements to your treatment and should become
approach to treatment, 80% of people with back part of your life-long fitness (see Physical Therapy).
pain improve in about 6 weeks and return to normal
Holistic therapies: Some patients want to try
activity. If you don’t respond to conservative
holistic therapies such as acupuncture, acupressure,
treatment, your doctor may recommend surgery.
nutritional supplements, and biofeedback. The
effectiveness of these treatments for a herniated
Nonsurgical treatments disc may help you learn coping mechanisms for
Self care: In most cases, the pain from a herniated managing pain as well as improving your overall
disc will get better within a couple days and health.
completely resolve in 4 to 6 weeks. Restricting your
activity, ice/heat therapy, and taking over the
counter medications will help your recovery (see
Self Care for Neck & Back Pain).
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Surgical treatments The key to avoiding recurrence is prevention:
Surgery for a herniated lumbar disc, called a • Proper lifting techniques (see Self Care for Neck
discectomy, may be an option if your symptoms do & Back Pain)
not significantly improve with conservative • Good posture during sitting, standing, moving,
treatments. Surgery may also be recommended if and sleeping (see Posture for a Healthy Back)
you have signs of nerve damage, such as weakness • Appropriate exercise program to strengthen
or loss of feeling in your legs. weak abdominal muscles and prevent re-injury
(see Exercise for a Healthy Back)
Microsurgical discectomy: The surgeon makes a • An ergonomic work area
1–2 inch incision in the middle of your back. To • Healthy weight and lean body mass
reach the damaged disc, the spinal muscles are • A positive attitude and stress management
dissected and moved aside to expose the vertebra. • No smoking
A portion of the bone is removed to expose the
nerve root and disc. The portion of the ruptured Sources & links
disc that touches your spinal nerve is carefully If you have more questions, please contact Mayfield
removed using special instruments. About 80–85% Brain & Spine at 800-325-7787 or 513-221-1100.
of patients successfully recover from a discectomy
and are able to return to their normal job in http://www.spine-health.com
approximately 6 weeks [2]. http://www.spineuniverse.com
http://www.neurosurgery.org/health/patient
Minimally invasive microendoscopic
discectomy: The surgeon makes a tiny incision in Sources
the back. Small tubes called dilators are used with 1. MedlinePlus Medical Encyclopedia
increasing diameter to enlarge a tunnel to the 2. American Association of Neurological Surgeons
vertebra. A portion of the bone is removed to and the Congress of Neurological Surgeons
expose the nerve root and disc. The surgeon uses
either an endoscope or a microscope to remove the
Glossary
ruptured disc. This technique causes less muscle
annulus (annulus fibrosis): tough fibrous outer
injury than a traditional discectomy.
wall of an intervertebral disc.
disc (intervertebral disc): a fibrocartilagenous
Clinical trials cushion that separates spinal vertebrae. Has two
Clinical trials are research studies in which new parts, a soft gel-like center called the nucleus and
treatments—drugs, diagnostics, procedures, and a tough fibrous outer wall called the annulus.
other therapies—are tested in people to see if they nucleus (nucleus pulposus): soft gel-like center
are safe and effective. Research is always being of an intervertebral disc.
conducted to improve the standard of medical care. sciatica: pain that courses along the sciatic nerve
Information about current clinical trials, including in the buttocks and down the legs. Usually caused
eligibility, protocol, and locations, are found on the by compression of the fifth lumbar spinal nerve.
Web. Studies can be sponsored by the National vertebra (plural vertebrae): one of 33 bones that
Institutes of Health (see clinicaltrials.gov) as well as form the spinal column, they are divided into 7
private industry and pharmaceutical companies cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4
(see www.centerwatch.com). coccygeal. Only the top 24 bones are moveable.
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