A herniated disk, also referred to as a slipped disk or disk prolapse, is a common condition that can be extremely painful and debilitating.
Although the symptoms brought on by a herniated disk are generally relieved after a number of weeks, a surgical procedure is sometimes required if symptoms persist or get worse.
In this article, we will discuss what a herniated disk entails, its diagnosis, treatment, and prevention.
Contents of this article:
Fast facts on herniated disks
Here are some key points about herniated disks. More detail and supporting information is in the main article.
- Herniated disk pain normally clears up within 4-6 weeks
- The human backbone consists of 26 vertebrae
- Many people have herniated disks with little or no symptoms
- Ultrasound can relieve disk prolapse symptoms for some individuals
What is a herniated disk?
Herniated disks are also referred to as slipped disks.
The human backbone, or spine, consists of 26 bones called vertebrae. Between each vertebrae lie rubbery, cushion-like pads referred to as "disks." These disks help keep the vertebrae in place and act as shock absorbers.
Spinal disks have been likened to doughnuts with a soft, jelly center and a tougher exterior.
A herniated disk occurs when some of the soft interior slips out through a crack in the disk's wall. Most commonly, this occurs in the back, but it can also happen in the vertebrae of the neck.
The escape of this "jelly" is thought to release chemicals that directly irritate nerves in the surrounding area and cause significant pain. There is also a chance that the prolapsed disk can press up against nerves and cause pain through compression.
A herniated disk can lead to numbness or weakness in one or more limbs. Conversely, some people experience no associated pain with a herniated disk, particularly if the disk does not press on any nerves.
One small study on symptom-free volunteers found that 50 percent had some degree of herniated disk that did not cause them any discomfort.
Symptoms of herniated disk
Although some cases of slipped disks are not associated with any symptoms, many are, and they can include:
- Numbness and tingling: this can occur in the region of the body supplied by the affected nerve.
- Weakness: muscles being supplied by the affected nerve may become weaker, causing stumbling when walking.
- Pain: with herniated disks in the lower back, the pain is generally in the buttocks, thighs, calves and, possibly, feet; this is often referred to as sciatica because the pain travels along the path of the sciatic nerve. If the problem lies in the neck, the pain normally affects the shoulders and arms. Quick movements or sneezing might induce shooting pains.
Causes of herniated disks
Herniated disks are often caused by wear and tear.
Often, the cause of a herniated disk is simple wear and tear of the disk from repeated movement over time.
With age, spinal disks lose some of their water content; this reduction in fluid means that the disks are less supple and, therefore, more liable to split.
It is not always possible to recall the exact point when a problem with a disk begins; however, it often occurs when lifting objects without bending at the knee or twisting when lifting a heavy item.
Risk factors for herniated disks
Herniated disks can happen at any age, but they are most common for individuals in their 20s and 30s. Factors that increase the likelihood of a herniated disk include:
- Weight: being overweight puts additional stress on the lower back
- Genetics: a predisposition to herniated disks might be inherited
- Occupation: individuals with physically demanding jobs or pastimes that involves pushing, pulling, or twisting
Complications of herniated disks
Below the waistline, the spinal cord separates into individual nerves, collectively referred to as the cauda equina (meaning "horse's tail"). On rare occasions, this entire set of nerves can become compressed.
If this occurs, it can cause permanent weakness, paralysis, loss of bowel and bladder control, and sexual dysfunction; if this occurs, emergency surgery is the only option.
Seek medical advice if:
- There is any bladder or bowel dysfunction
- The weakness progresses and prevents normal activities
- Numbness around the inner thighs, back of legs, and rectum (saddle anesthesia) gets progressively worse
Diagnosis of herniated disks
Often, a doctor can diagnose a herniated disk with a physical exam; she may check:
- Possibility of tender regions in the back
- Muscle strength
- Range of motion
- Walking ability
- Sensitivity to touch
The doctor might order an X-ray; although X-rays do not show herniated disks, they can rule out other potential explanations for the patient's symptoms. Other types of imaging can provide more detail as to the whereabouts of the herniated disk:
- Magnetic resonance imaging (MRI): using radio waves and magnetic pulses, MRI scans create detailed images of the body. These images can pinpoint the location of the disk and the affected nerves.
- Computerized tomography (CT): CT scans take a series of X-rays to create cross-sectional images of the spine and the tissues surrounding it.
- Discogram (discography): dye will be injected into the soft center of one or more disks. Doing so can help pinpoint cracks in individual disks.
- Myelogram: dye is injected into the spinal fluid and then X-rayed; this can show pressure on the spinal cord and nerves caused by herniated disks.
Treatment of herniated disks
The recovery time for herniated disks is normally around 4 weeks with treatment.
Although herniated disks can be incredibly painful, in general, with the right treatment, symptoms will be relieved.
Most people who experience a herniated disk will recover within 4 weeks. By avoiding the types of movement that trigger pain and by following exercise and pain medication regimens, the majority of herniated disk patients find symptoms are relieved.
Treatment options are split into medication, therapy, and surgery.
- Over-the-counter medication (OTC): if the pain is moderate or mild, OTC medications can suffice, these include ibuprofen- or naproxen-based drugs.
- Nerve pain medications: these can help with the pain associated with damaged nerves. Nerve pain medications are commonly used because, compared with narcotics, their side effects are less severe. They include gabapentin, pregabalin, duloxetine, and amitriptyline.
- Narcotics: these include codeine or an oxycodone-acetaminophen combination and are prescribed if OTC medications do not alleviate discomfort. Side effects can include nausea, sedation, confusion, and constipation.
- Cortisone injections: these can be injected directly into the troubled area to help reduce inflammation and the pain it causes.
- Epidural injections: injected into the epidural space (an area around the spinal cord). Steroids, anesthetics, and anti-inflammatory medications may be injected to minimize pain and swelling in and around spinal nerve roots.
- Muscle relaxants: these help if muscle spasms are an issue. Dizziness and sedation are common side effects.
Physical therapists help patients find positions and exercises that minimize the pain caused by the herniated disk.
Therapists may also recommend:
- Treatment with heat or ice
- Ultrasound: using high-frequency sound to stimulate the affected area and improve blood flow
- Traction: the use of ropes, weights, and pulleys to apply force to tissues
- Short-term bracing for the neck or lower back to improve support
- Electrotherapy: electric impulses might reduce pain for some patients
Surgery is only called for to treat a herniated disk if symptoms persist.
If all other treatments are unsuccessful, surgery might be considered. For instance, if symptoms do not improve, if numbness persists, or if bladder control or mobility worsens, surgery may be called for.
In the majority of cases, only the protruding portion of the disk is removed; this is referred to as an open discectomy.
This type of surgery is often conducted using a laparoscopic technique which involves opening a small hole in the abdomen and approaching the spine from the front of the body.
There are a number of reasons for entering from the front of the body rather than the back; laparoscopy avoids the need to remove small portions of the vertebrae or move the spinal nerves and spinal cord to get access to the disc.
Less commonly, the entire disk might need to be removed. This normally requires the insertion of metal supports between the remaining disks to ensure spinal stability.
Artificial disk replacement
Disk replacement procedures have been carried out since the 1980s in Europe but are not yet available in the U.S. There are two types; the first is a total disk replacement, the second is a disk nucleus replacement that involves replacing just the soft center of the disk, known as the nucleus.
Artificial disks are constructed of metal, biopolymer (a plastic-like substance), or both.
Thankfully, herniated disks are typically manageable without requiring an invasive procedure.