Herniated Disk
Also known as: ruptured disk, herniated
nucleus pulposus, prolapsed disk, ruptured
intervertebral disk, or slipped disk.
What is it?
A herniated disk is a common cause of lower back
pain. Disks are round, flat, plate-like structures
between the vertebrae (back bones) in the spinal
column. They have a tough covering over a soft,
gelatinous inside (nucleus pulposus), and their purpose
is to cushion the back bones and allow the back to
flex. A hernia is a tear in the covering of the disk
that allows the soft interior to bulge out.
Who gets it?
A herniated disk is more likely to occur in people
between the ages of 20 and 50, with a higher occurrence
in men. People whose professions require a great deal
of heavy lifting and people who are obese are at
greater risk.
What causes it?
A herniated disk can be caused by any type of
intense pressure on the disk by the vertebrae above and
below it. This could be caused by lifting a heavy
object improperly, by sudden twisting, by a weakening
of the disk covering that occurs with age, or by
traumatic injury to the back area. Obesity can also put
pressure on the disks, and smoking can contribute to
degeneration of the disk material. When the soft
interior of the disk bulges out, it places pressure on
the nearby nerves of the spinal cord.
What are the symptoms?
The most common symptom of a herniated disk is lower
back pain following a fall, injury to the back, or
after lifting a heavy object. The path the pain follows
depends upon which disk is herniated and which spinal
nerve is inflamed or damaged. Pain that radiates from
the lower back area, through the hip or buttocks, and
down the back of the thigh to the knee or the whole way
to the foot is a sign of sciatica. Sciatica is caused
by pressure on the sciatic nerve, which follows this
path on either side of the body. Other symptoms of a
herniated disk can include a tingling or numb sensation
in a leg or loss of bladder or bowel control.
How is it diagnosed?
To diagnose a herniated disk, your doctor will study
your medical history, ask about what you were doing at
the time the pain developed, and ask you to describe
the location of the pain. He or she will perform a
thorough physical examination. You may also have x-rays
of the spinal area, or your doctor may order:
- Magnetic Resonance Imaging (MRI) or Computed
Tomography (CT) scans to determine where and how
badly the disk is damaged.
- Myelography, in which dye or air is injected into
the spinal canal before x-rays are taken.
- An electromyogram (EMG), which measures the
muscle’s electrical activity of and reveals nerve
damage.
What is the treatment?
In most cases, a herniated disk will heal on its own
with around two days of bed rest, over-the-counter pain
relievers to help with the discomfort, and
anti-inflammatory medications. Your doctor will
recommend how and when to treat the condition with cold
or heat packs, and when you can gradually resume
activity. You will need to avoid any type of lifting
until the injury has healed. It is extremely important
to learn to lift objects properly to avoid re-injury.
Some patients who do not recover with this treatment
require injections of an anti-inflammatory medication
into the spinal area. If the disk has fragmented, your
doctor may recommend surgery to remove the pieces of
the disk that are compressing the nerve. There are many
types of surgical techniques for repairing a herniated
disk. With a laminectomy, the surgeon removes any
fragments of the disk that are pressing on the nerve,
as well as a part of the vertebra called the lamina.
Microsurgical techniques require smaller incisions and
only a local anesthetic. Some types of herniated disk
surgeries can be performed on an outpatient basis. The
extent of your injury, as well as your age and overall
health, will help determine the type of surgery that is
best for you. Surgery is followed by physical therapy
to strengthen the back and help you resume normal
activities.
Self-care tips
You can help prevent a herniated disk by avoiding
sudden twisting motions, learning to lift heavy objects
properly, or avoiding heavy lifting. If your job
requires frequent heavy lifting, make sure you wear a
protective back supporting device while on the job. A
strong and flexible lower back, strong abdominal
muscles, and good posture go a long way in preventing
back injuries. Your doctor can recommend an exercise
program that is right for you. If you are overweight,
ask your doctor to recommend a healthy weight loss
program. Avoid smoking to preserve your overall health.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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