Spinal disc herniation (patient information)
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What is Spinal disc herniation?
A herniated (slipped) disc occurs when all or part of a [spinal disc] is forced through a weakened part of the disc. This places pressure on nearby [nerves].
What are the symptoms of Spinal disc herniation?
[Low back] or [neck] [pain] can vary widely. It may feel like a mild [tingling], dull [ache], or a [burning] or [pulsating] [sensation]. In some cases, the [pain] is severe enough that you are unable to move. You may also have [numbness].
The pain most often occurs on one side of the body.
- With a [lumbar] (lower back) [herniated disc], you may have sharp [pain] in one part of the [leg], [hip], or [buttocks] and [numbness] in other parts. You may also feel the [sensation]s on the back of the [calf] or [sole] of the [foot]. The affected [leg] may feel weak.
- With a cervical (neck) disc herniation, you may have pain when moving your [neck], deep pain near or over the [shoulder blade], or pain that radiates to the [upper arm], [forearm], or (rarely) [finger]s.
The pain often starts slowly. It may get worse:
- After standing or sitting
- At night
- When sneezing, coughing, or laughing
- When bending backwards or walking more than a few yards, especially if it is caused by [spinal stenosis]
You may also have weakness in certain [muscle]s. Sometimes, you may not notice it until your doctor examines you. In other cases, you will notice that you have a hard time lifting your [leg] or [arm], standing on your [toes] on one side, squeezing tightly with one of your [hand]s, or other problems.
The [pain], [numbness], or [weakness] often will go away or improve a lot over a period of weeks to months.
What are the causes of Spinal disc herniation?
The [bones] (vertebrae) of the [spinal column] run down the [back], connecting the [skull] to the [pelvis]. These bones protect [nerves] that come out of the [brain] and travel down your [back], forming the [spinal cord]. [Nerve roots] are large [nerve]s that branch out from the spinal cord and leave your [spinal column] between each vertebrae.
- The [spinal vertebrae] are separated by [disc]s filled with a soft, gelatinous substance. These discs cushion the [spinal column] and space between your [vertebrae].
- These discs may [herniate] (move out of place) or [rupture] from [trauma] or [strain]. When this happens, the [spinal nerve]s may become compressed, resulting in pain, numbness, or weakness.
- The lower back (lumbar area) of the spine is the most common area for a slipped disc. The [cervical] (neck) discs are affected 8% of the time. The upper-to-mid-back ([thoracic]) discs are rarely involved.
Radiculopathy refers to any disease that affects the spinal nerve roots. A herniated disc is one cause of [radiculopathy] ([sciatica]).
[Disc herniation] occurs more frequently in middle-aged and older men, especially those involved in strenuous physical activity. Other risk factors include any conditions present at birth ([congenital]) that affect the size of the [lumbar spinal canal].
Who is at risk for Spinal disc herniation?
People that have the following factors may be at risk:
- Age. [Herniated disc]s are most common in middle age, especially between 35 and 45, due to aging-related degeneration of the discs.
- Smoking. Smoking tobacco increases your risk of disc herniation because it decreases [oxygen] levels in your [blood], depriving your body [tissues] of vital nutrients.
- Weight. Excess body weight causes extra [stress] on the discs in your [lower back].
- Height. Being tall increases your risk of disc herniation. Men taller than 5 feet 11 inches (180 centimeters) and women taller than 5 feet 7 inches (170 centimeters) appear to have a greater risk of a herniated disc.
- Occupations that [strain] your [spine]. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disc. Jobs that require prolonged sitting or standing in one position also may increase your risk of disc herniation. [1]
How to know you have Spinal disc herniation?
Once symptoms become apparent consult a doctor. After asking you questions and giving you an exam, your doctor may take [X-rays] and other pictures to see whether or not yo have a herniated disc. [2]
When to seek urgent medical care
Call your health care provider if:
- you develop persistent, severe back pain
- you have any numbness, loss of movement, weakness, or bowel/bladder changes
Treatment options
The first treatment for a herniated disc is a short period of rest with pain and [anti-inflammatory] [medication]s, followed by [physical therapy]. Most people who follow these treatments will recover and return to their normal activities. A small number of people need to have further treatment, which may include [steroid injection]s or [surgery].
Medication:
[Nonsteroidal] [anti-inflammatory] [medication]s (NSAIDs) and [narcotic] painkillers will be given to people with a sudden herniated disc caused by some sort of injury (such as a car accident or lifting a very heavy object) that is immediately followed by [severe pain] in the [back] and [leg].
If you have [back] [spasm]s, you will usually receive [muscle relaxants]. On rare occasions, [steroid]s may be given either by pill or directly into the [blood] through an IV.
NSAIDs are used for long-term pain control, but [narcotics] may be given if the pain does not respond to [anti-inflammatory] drugs.
Lifestyle Changes:
Diet and exercise are crucial to improving back pain in overweight patients.
[Physical therapy] is important for nearly everyone with disc disease. Therapists will tell you how to properly lift, dress, walk, and perform other activities. They will work on strengthening the [muscles] that help support the [spine]. You will also learn flexibility of the spine and [legs].
Injections:
[Steroid injections] into the back in the area of the herniated disc may help control pain for several months. Such injections reduce [swelling] around the disc and relieve many [symptoms]. Spinal injections are usually done on an outpatient basis, using x-ray or [fluoroscopy] to identify the area where the injection is needed.
Surgery:
[Surgery] may be an option for the few patients whose symptoms do not go away despite other treatments and time.
Ask your doctor which treatment options are best for you.
Diseases with similar symptoms
Where to find medical care for Spinal disc herniation
Directions to Hospitals Treating Spinal disc herniation
Prevention of Spinal disc herniation
Safe work and play practices, proper lifting techniques, and weight control may help prevent back injury in some people.
Some health care providers recommend the use of [back brace]s to help support the [spin]e. Such [braces] can help prevent injuries in people whose work requires them to lift heavy objects. However, overuse of these devices can weaken the [abdominal] and [back] [muscle]s, making the problem worse.
What to expect (Outlook/Prognosis)
Most people will improve with conservative treatment. A small percentage may continue to have [chronic] back pain even after treatment.
It may take several months to a year or more to resume all activities without pain or strain to the back. People with certain occupations that involve heavy lifting or back strain may need to change job activities to avoid recurrent back injury.
Possible Complications:
- Long-term back pain
- Loss of movement or sensation in the legs or feet
- Loss of bowel and bladder function
- Permanent spinal cord injury (very rare)
Sources
Essentials of Musculoskeletal Care by Walter B. Greene, MD
References