Herniated Disc
Herniated Disc
(Disc, Herniated; Herniation of Nucleus Pulposus [HNP]; Prolapsed Disc; Ruptured Disc; Slipped Disc)
Definition
| Herniated Lumbar Disc |
|
| Copyright © Nucleus Medical Media, Inc. |
Causes
Risk Factors
- Age: 30s and 40s
- Trauma from a fall, accident, or sudden twisting
- Strain on the back—either repeated or sudden (as from lifting a heavy weight)
- Certain jobs that require heavy lifting
Symptoms
-
Pain—how severe the pain is depends on which disc is herniated and how large the herniation is
- Pain may spread over the buttocks, down the back of one thigh, and into the calf
- Pain may be in one leg (more common) or both legs
- Numbness, tingling, or weakness in the legs or feet
- Numbness, tingling, or weakness in one or both arms
- In severe cases, inability to find comfort even lying down
- Sudden aching or twisted neck that cannot be straightened without severe pain
-
Cauda equina syndrome—involves bowel or bladder changes and/or numbness in the groin
- Note: This is an emergency, Call 911
Diagnosis
Treatment
Physical Medicine
- Bed rest
-
During acute phase,
back or neck massage and physical therapy to:
- Relax the neck or back muscles
- Decrease pain
- Increase strength and mobility
- Back and abdominal exercises during recovery phase
- Hot or cold packs—to reduce pain and muscle spasms
-
Stretches
for the spine:
- A doctor or chiropractor can sometimes help reduce pain by stretching your spine
- Any spinal manipulation must be done carefully by an experienced, licensed practitioner
- Traction (weights and pulleys)—to relieve pressure on the discs and keep you from moving around (more common for discs in the neck area)
- Neck collar or brace for a herniated disc in the neck—to relieve muscle spasms
Medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs)—to reduce inflammation and pain (such as, ibuprofen , naproxen )
- Muscle relaxants—to reduce muscle spasms
- Pain medications
Interventional Spine Care
- Steroid injections into the area around the nerve and disc. It is done to reduce pain and inflammation. The injections are used if other medications do not work.
-
Minimally invasive procedures may include:
- Nucleoplasty
- Intradiscal electrothermy (IDET)
- Chemonucleolysis
Surgery
- Laminectomy—removal of some of the bone over the spine and of the problem disc
- Microdiskectomy—removal of fragments of herniated disc through a small incision (also known as intervertebral diskectomy)
- Spinal fusion—fusing of vertebrae (back bones) together with bone grafts or metal rods (rarely done for first-time disc problems)
Prevention
- Practice good posture. Stand and sit straight, and keep your back straight when lifting.
- Maintain a healthy weight.
- Exercise regularly. Ask your doctor about exercises to strengthen your back and stomach.
- Don't wear high-heeled shoes.
- If you sit for long periods of time, use a stool to bring your knees above your hips.
RESOURCES
American Academy of Orthopedic Surgeons http://www.aaos.org
American Chiropractic Association http://www.acatoday.org
CANADIAN RESOURCES
Canadian Orthopaedic Association http://www.coa-aco.org
Canadian Orthopaedic Foundation http://www.canorth.org
References
Awad JN. Moskovich R. Lumbar disc herniations: surgical versus nonsurgical treatment. Clinical Orthopaedics & Related Research. 2006;443:183-197.
Ellenberg M, Honet JC. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Hanley and Belfus; 2002, chap 46.
Goldmann DR. American College of Physicians Complete Home Medical Guide. New York, NY: DK Publishing; 1999.
Slipman CW, Derby R, Simeone FA, Mayer TG. Interventional Spine: An Algorithmic Approach. Philadelphia, PA: Saunders Elsevier; 2008.
When you have a herniated disc. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/2003/0515/p2195.html. Published 2003. Accessed July 2, 2008.
