Back PainBones / OrthopedicsNeurology / Neuroscience

Herniated disk: What you should know

A herniated disk is a common, painful and debilitating condition. People sometimes refer to it as a prolapse of a slipped disk or disk. It can in some cases cause pain , numbness, or weakness in the limbs.

Some people do not feel any pain, however, particularly if the disk doesn’t press on any nerves.

Symptoms usually decrease or resolve after a number of weeks but if they continue or get worse, a person can need surgery.

This article will explore how a herniated disk is treated, diagnosed, and prevented.

Important facts about herniated disk

  • A herniated disk occurs in the vertebrae.
  • Any pain normally resolves within a few months.
  • Herniated disks might cause few or no symptoms.
  • Treatments include medication, physical therapy, epidural injections, and surgery.

Treatment

Herniated disks can range from causing severe pain to no pain at all.
Herniated disks can range from causing severe pain to no pain at all.

Herniated disks may cause severe pain but symptoms may be relieved by the proper treatment.

Mostly, a person may relieve symptoms by avoiding movements that cause pain and following the regimens of exercise and pain medicine prescribed by a doctor.

Treatment options include medication, treatment, and surgery.

Medication

Over-the-counter medication (OTC): prescription products on ibuprofen or naproxen can help with mild to moderate pain.

  • Nerve pain medications: Medications for treating nerve pain include gabapentin, pregabalin, duloxetine, and amitriptyline.
  • Narcotics: If OTC medications do not relieve discomfort, a doctor might prescribe codeine, a combination of oxycodone and acetaminophen, or another type of narcotic. Side effects include nausea, sedation, confusion, and constipation.
  • Cortisone injections: These can be injected directly into the area of the herniation to help reduce inflammation and pain.
  • Epidural injections: A doctor injects steroids, anesthetics, and anti-inflammatory medications into the epidural space, which is an area around the spinal cord. This can help minimize pain and swelling in and around the spinal nerve roots.
  • Muscle relaxants: These help reduce muscle spasms. Dizziness and sedation are common side effects.

Physical therapy

Physical therapists may help in finding positions and exercises that alleviate herniated disk pain.

Therapists may also recommend:

  • treatment with heat or ice
  • ultrasound, which uses sound waves to stimulate the affected area and improve blood flow
  • traction, which can alleviate pressure on the affected nerve
  • short-term bracing for the neck or lower back, to improve support
  • electrotherapy, as electric impulses might reduce pain for some people

Surgery

The treating doctor may recommend surgery if symptoms do not improve with other treatments, if numbness persists, or if bladder control or mobility worsens.

The surgeon normally only removes the protruding part of the disk. This is an absolute discectomy.

Typically, the surgeon performs open discectomy using a laparoscopic procedure, opening a small hole either at the front or back of the spine.

This procedure prevents having to cut small parts of the vertebrae or move the spinal nerves and spinal cord in order to reach the disk.

Artificial disk replacement

Surgeons have been in Europe since the 1980s conducting disk replacement operations but are not yet available in the United States.

There are two forms of this. The first is a replacement of the entire disk. The second is a disk nucleus replacement that involves replacing only the soft center of the disk, known as the nucleus.

Metal, biopolymer, or both are artificial disks. A biopolymer is a substance similar to plastic.

Causes

If the soft internal portion of an intervertebral disk protrudes through the outer layer, a slipped disk occurs.

The human spine, or spine, is made up of 26 bones called vertebrae. Rubbery, cushion-like pads, called “disks” lie between each vertebrae. Such disks help to hold the vertebrae in place and serve as shock absorbers.

Spinal disks have a soft center, jelly-like, and a tougher exterior.

If any of the soft interior slips out through a crack in the disk wall, a herniated disk occurs. This occurs most commonly in the lower back but can also occur in the neck vertebrae.

The escape from this “jelly” is thought to release chemicals in the surrounding area that irritate the nerves and cause severe pain. The prolapsed disk will also place pressure on the nerves and compression will cause pain.

A leaking disk is typically caused by gradual wear and overuse as a result of repetitive motion over time.

When a person ages, the spinal disks lose some of their water content. This fluid reduction makes the disks less supple and more susceptible to split.

Remembering the exact point where a disk problem starts is not always possible, but it sometimes occurs while lifting items without bending at the knee or twisting when lifting a heavy item.

Risk factors

lifting heavy load
Unsafe lifting techniques can lead to a herniated disk. Learn the correct techniques.

Herniated disks can occur at any age but are most common among men aged 20 to 50 years.

Factors which increase probability include:

  • Weight: Being overweight puts additional stress on the lower back.
  • Genetics: A person might inherit a predisposition to herniated disks.
  • Occupation: Individuals with physically demanding jobs or pastimes that involve pushing, pulling, or twisting are prone to herniated disks. Any repetitive activities that strain the spine can cause them.
  • Unsafe lifting technique: People should always apply force from the legs, not the back, when lifting heavy items. Incorrect technique can lead to a herniated disk.
  • Driving often: A combination of being seated for long periods and the vibrations and movements of the car can damage the disks and spinal structure.
  • Sedentary lifestyle: A lack of exercise can lead to a herniated disk.
  • Smoking: This might reduce oxygen supply to the disks and lead to a grinding-down of the tissue.

Symptoms

A person may in some cases have no symptoms.

When symptoms occur, they are often related to nerve pressure. Symptoms common to all can include:

  • Numbness and tingling: This occurs in the region of the body that the nerve supplies.
  • Weakness: This tends to occur in the muscles linked to the nerve, which may cause stumbling when walking.
  • Pain: This occurs in the spine and can spread to the arms and legs.

The pain often affects the buttocks, thighs, calves, and possibly feet if the herniated disk is in the lower back. This is also called sciatica, since the pain moves along the sciatic nerve path.

If the problem occurs at the neck, the pain normally occurs to the shoulders and arms. Quick or sneezing movements can cause shooting pains.

Complications

Under the waistline, the spinal cord divides into a group of individual nerves, collectively referred to as cauda equina or “horse tail.”

In rare instances this whole set of nerves can be compressed by a herniated disk.

It can cause irreversible fatigue, paralysis, loss of control over the bowel and bladder, and sexual dysfunction.

When this occurs the only option is emergency surgery.

Seek medical advice if:

  • There is any bladder or bowel dysfunction.
  • The weakness progresses and prevents normal activities.
  • There is increasing numbness around the inner thighs, the backs of the legs, and the rectum.
MRI scans can help diagnose a herniated disk
MRI scans can help diagnose a herniated disk

A doctor can often diagnose a herniated disk with a physical exam.

They might check:

  • reflexes
  • possibility of tender regions in the back
  • muscle strength
  • range of motion
  • walking ability
  • sensitivity to touch

An X-ray can help rule out similar symptoms in other conditions. Other types of imaging can provide more detail on where the herniated disk is located, such as:

  • MRI or CT images: These can pinpoint the location of the disk and the affected nerves.
  • A discogram: This involves injecting dye into the soft center of one or more disks to help pinpoint cracks in individual disks.
  • A myelogram: This is the process of injecting dye into the spinal fluid then taking an x-ray image. A discogram can show whether a herniated disk is exerting any pressure on the spinal cord and nerves.

Prevention

Tips for preventing a herniated disk include:

  • avoiding obesity or losing weight, if necessary
  • learning the correct techniques for lifting and handling
  • resting and seeking help if symptoms occur

Although it can sometimes be extremely painful, a herniated disk has many promising treatment options.

Q:

What lifestyle changes can help support a person with a herniated disk?

A:

Some of the most critical aspects to have during the everyday activities is to maintain a healthy posture.

Keep your spine straight while you lift. Do not slump to collect items from the floor, and sit back with support and without rounding the back. Both of these are ways of reducing disk pain and stress.

Another critical move in avoiding disk problems is the regular change of positions during the day. A disk injury may be irritated by sitting in or standing in the same position for long periods.

You should move around or change positions and stretch every 30 minutes.

Answers represent our medical experts’ opinions. All material is purely informational and medical advice should not be considered.

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