In some cases, it can lead to numbness or weakness in one or more limbs, but 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 surgery may be needed if they persist or get worse.
In this article, we will discuss what a herniated disk entails, its diagnosis, treatment, and prevention.
Here are some key points about herniated disks. More detail is in the main article.
Recovery normally takes around 4 weeks with treatment.
Herniated disks can be painful, but the right treatment can relieve symptoms.
Most people who experience a herniated disk will recover within 4 weeks.
Symptoms can mostly be resolved by avoiding the types of movement that trigger pain and by following exercise and pain medication regimens.
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: Codeine, an oxycodone-acetaminophen combination, or another type of narcotic can be prescribed if OTC medications do not relieve discomfort. Side effects include nausea, sedation, confusion, and constipation.
- Cortisone injections: These can be injected directly into the troubled area to help reduce inflammation and pain. Steroid medications should be used sparingly because of their adverse effects.
- Epidural injections: Injected into the epidural space—an area around the spinal cord—steroids, anesthetics, and anti-inflammatory medications can help minimize pain and swelling in and around spinal nerve roots.
- Muscle relaxants: These help reduce muscle spasms. Dizziness and sedation are common side effects.
Physical therapists help find positions and exercises that minimize the pain caused by the herniated disk.
Therapists may also recommend:
- treatment with heat or ice
- ultrasound, where using high-frequency sound is to stimulate the affected area and improve blood flow
- traction, using ropes, weights, and pulleys to apply force to tissues
- short-term bracing for the neck or lower back to improve support
- electrotherapy, as electric impulses might reduce pain for some people
Surgery is only called for to treat a herniated disk if symptoms persist.
If symptoms do not improve with other treatments, if numbness persists, or if bladder control or mobility worsens, surgery may be recommended.
In most cases, only the protruding portion of the disk is removed. This is referred to as an open discectomy.
It is often conducted using a laparoscopic technique. The surgeon opens a small hole in the abdomen and approaches the spine from the front of the body.
This technique avoids the need to remove small portions of the vertebrae or to move the spinal nerves and spinal cord to get access to the disc.
Less commonly, the entire disk might need to be removed. Normally, metal supports will need to be inserted 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 United States.
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.
Herniated disks are typically manageable without requiring an invasive procedure.
Herniated disks are often caused by wear and tear.
The human backbone, or spine, consists of 26 bones called vertebrae. Between each vertebra 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. The prolapsed disk may also press up against nerves and cause pain through compression.
Often, the cause is wear, due to repeated movement over time.
With age, spinal disks lose some of their water content. This reduction in fluid leaves the disks less supple and more liable to split.
It is not always possible to recall the exact point when a problem with a disk begins, but it often occurs when lifting objects without bending at the knee or twisting when lifting a heavy item.
Herniated disks can happen at any age, but they are most common for individuals in their 20s and 30s.
Factors that increase the likelihood 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 involve pushing, pulling, or twisting
Herniated disks are also referred to as slipped disks.
In some cases, a person will have no symptoms.
If symptoms do occur, they can include:
- Numbness and tingling in the region of the body supplied by the affected nerve.
- Weakness in the muscles being supplied by the affected nerve, which may cause stumbling when walking.
- Pain in the back, shoulders or arms.
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 pain normally affects the shoulders and arms. Quick movements or sneezing might induce shooting pains.
One small study on symptom-free volunteers found that 50 percent had some degree of herniated disk that did not cause them any discomfort
Below the waistline, the spinal cord separates into individual nerves, collectively referred to as the cauda equina or "horse's tail."
Rarely, this entire set of nerves can become compressed.
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
- numbness around the inner thighs, back of legs, and rectum (saddle anesthesia) gets progressively worse
Often, a doctor can diagnose a herniated disk with a physical exam.
They may 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 whereabouts of the herniated disk:
- MRI or CT images can pinpoint the location of the disk and the affected nerves.
- Discogram (discography) involves injecting dye into the soft center of one or more disks to help pinpoint cracks in individual disks.
- A myelogram involves injecting dye into the spinal fluid and then taking an x-ray image. This can show if there is pressure on the spinal cord and nerves due to herniated disks.
Tips for preventing a herniated disk include:
- avoid obesity and excess weight, or lose weight if necessary
- learn correct techniques for lifting and handling
- rest and seek help if symptoms occur, to prevent them from worsening