A herniated disk is a common condition that can be painful and debilitating. People also refer to it as a slipped disk or disk prolapse. In some cases, it can lead to pain, numbness, or weakness in the limbs.
However, some people experience no pain, particularly if the disk does not press on any nerves.
Symptoms normally reduce or resolve after a number of weeks, but a person may need surgery if they persist or get worse.
This article will explore the treatment, diagnosis, and prevention of a herniated disk.
Herniated disks might cause severe pain, but the right treatment can relieve symptoms.
A person can mostly resolve symptoms by avoiding movements that trigger pain and following the exercise and pain medication regimens that a doctor has recommended.
Treatment options include medication, therapy, and surgery.
Over-the-counter medication (OTC): Ibuprofen- or naproxen-based drugs 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 therapists can help find positions and exercises that minimize 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
If symptoms do not improve with other treatments, if numbness persists, or if bladder control or mobility worsen, the treating doctor might recommend surgery.
In most cases, the surgeon removes only the protruding portion of the disk. This is an open discectomy.
The surgeon will usually conduct open discectomy using a laparoscopic technique, opening a small hole in either the front or back of the spine.
This technique avoids the need to remove small portions of the vertebrae or to move the spinal nerves and spinal cord to access the disk.
Artificial disk replacement
Surgeons have carried out disk replacement procedures since the 1980s in Europe but are not yet available in the United States.
There are two types. The first is a total disk replacement. The second is a disk nucleus replacement that involves replacing only the soft center of the disk, known as the nucleus.
Artificial disks are metal, biopolymer, or both. A biopolymer is a substance similar to plastic.
A slipped disk occurs when the soft internal section of an intervertebral disk protrudes through the outer layer.
The human backbone, or spine, consists of 26 bones called vertebrae. Between each vertebra lie rubbery, cushion-like pads called “disks.” These disks help keep the vertebrae in place and act as shock absorbers.
Spinal disks have a soft, jelly-like center and a tougher exterior.
A herniated disk occurs when some of the soft interior slips out through a crack in the wall of the disk. This most commonly occurs in the low back but can also occur in the vertebrae of the neck.
The escape of this “jelly” is thought to release chemicals that irritate nerves in the surrounding area and cause significant pain. The prolapsed disk may also put pressure on nerves and cause pain through compression.
The cause of a leaking disk is usually gradual wear and overuse as a result of repeated movement over time.
Spinal disks lose some of their water content as a person ages. This reduction in fluid makes the disks less supple and more prone to splitting.
It is not always possible to recall the exact point when a disk problem begins, but it often occurs when lifting objects without bending at the knee or after twisting while lifting a heavy item.
Herniated disks can occur at any age, but they are most common for men between the ages of 20 and 50 years.
Factors that increase the likelihood 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.
In some cases, a person will have no symptoms.
If symptoms occur, they are often due to pressure on the nerves. Common symptoms 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.
If the herniated disk is in the lower back, the pain often affects the buttocks, thighs, calves, and, possibly, the feet. This is often referred to as sciatica because the pain travels along the path of the sciatic nerve.
If the problem occurs in the neck, the shoulders and arms normally experience the pain. Quick movements or sneezing might induce shooting pains.
Below the waistline, the spinal cord separates into a group of individual nerves, collectively called the cauda equina or “horse’s tail.”
In rare instances, a herniated disk can compress this entire set of nerves.
This 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.
- There is increasing numbness around the inner thighs, the backs of the legs, and the rectum.
A doctor can often diagnose a herniated disk with a physical exam.
They might check:
- possibility of tender regions in the back
- muscle strength
- range of motion
- walking ability
- sensitivity to touch
An X-ray can help rule out other conditions with similar symptoms. Other types of imaging can provide more detail as to the location of the herniated disk, 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.
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.