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Herniated Disc

A herniated disc can occur in the cervical spine (neck) or lumbar spine (lower back). At right: The top disc has herniated, or "slipped," and is pressing on a nerve. A normal disc is shown at bottom.

The spine is made up of stacked bones called vertebrae. In between each of the vertebrae is a small disc that acts as a shock absorber. These discs are a little like jelly doughnuts in that each has a soft, gluey interior (called a nucleus) that is protected by a firm outer layer (called an annulus). Discs act as shock absorbers for the spine.

Herniated discs are often referred to as slipped disc or ruptured discs. The condition results from a tear in the outer layer of a disc. It can happen in any part of the spine, but is most common in the lumbar (lower back) or cervical (neck) regions of the spine. Herniated discs can happen to people of ages, including children, and effect both men and women.

A herniated disc happens when the nucleus is pushed out of the annulus through a rupture, or tear. The “slipped” disc presses on the nerves in the spine, causing pain that can be quite severe. Sometimes the surrounding nerves can also become irritated, causing pain, numbness, or weakness in the arms and legs.

Causes
Herniated discs can occur from excessive strain or injury, or degeneration due to age. They can be prevented.

Prevention
The following preventive measures can help prevent herniated discs, or keep them from recurring:

  • Strengthen the abdominal muscles to support the back and improve posture. Exercises to strengthen the abs include crunches, variations of sit-ups, and other exercises to provide more spine stability. (See the exercises in our Guide to a Better Back.)
  • Use proper form when lifting (ie, lift from the knees).
  • Avoid stress, which can cause back tension.
  • Keep your weight at a healthy level. Extra pounds can put pressure and strain on the back.

Most patients with a herniated disc make a full recovery after treatment.

Symptoms of a Herniated Disc
If the ruptured disc is not pressing on a nerve there may be no symptoms at all, or there may be some minimal pain. If the disc is pressing on a nerve, symptoms may include pain in the back or neck, leg or arm pain, weakness, numbness or tingling.

Symptoms of a lumbar (lower back) herniated disc include:

  • Intermittent or continuous back pain (this may be made worse by movement, coughing, sneezing, or standing for long periods of time
  • Spasm of the back muscles
  • Pain that starts near the back or buttock and radiates down the leg to the calf or into the foot (this is from “sciatica,” meaning pressure on the large sciatic nerve in the lower back, buttocks, and legs
  • Muscle weakness in the legs
  • Numbness in the leg or foot
  • Decreased reflexes at the knee or ankle

Symptoms of a cervical (neck) herniated disc:

  • Pain between the shoulder blades that can be dull or sharp
  • Pain that radiates down the arms to the hands
  • Muscle spasms
  • Numbness , tingling, or weakness in the arms, hands, or fingers
  • Muscle atrophy

The symptoms of a slipped disc vary from person to person, depending on the size and location of the herniation, how overweight or fit a person is, and other factors.

Sometimes a herniated disc can lead to another condition called spinal cord compression. This happens when pressure is placed on the spinal cord. There may be edema (swelling) of the cord, as well. Symptoms may come on either suddenly or gradually and may include:

  • Difficulty walking
  • Balance problems
  • Falling
  • Dropping things
  • Difficulty with fine-motor skills such as buttoning, handwriting, or picking up small objects
  • Arm or leg weakness, cramping
  • Changes in bladder or bowel function

Minimally invasive surgery can reduce the swelling and stop the progression of symptoms of spinal cord compression.

Diagnosis and Treatment
A herniated disc can occur in the cervical spine (neck) or lumbar spine (lower back). At right: The top disc has herniated, or "slipped," and is pressing on a nerve. A normal disc is shown at bottom.

A herniated disc is often diagnosed by a physician after a patient complains of back, neck or extremity pain. The physician will gather history and symptoms and conduct a physical examination. If a slipped disc is suspected, the physician will usually order imaging tests to confirm the diagnosis.

Diagnostic tests may include:

Computerized tomography (CT) is a noninvasive procedure that uses x-rays to produce a three-dimensional image of the spine. A CT scan may show evidence of a ruptured disc.

Magnetic resonance imaging (MRI) scans are the best tools for diagnosing a slipped disc. An MRI uses magnetic fields and radio-frequency waves to create an image of the spine, and can reveal the details of the disc, the nucleus (the jelly-like substance within) and the annulus ( the firm outer layer). An MRI scan can also show evidence of previous injuries that may have healed and other details in the spine that can’t normally be seen on an x-ray.

Myelogram: This special x-ray uses dye, which is injected into the spinal fluid. This can identify a ruptured disc. Usually a CT scan follows the Myelogram.

Electromyogram and Nerve Conduction Studies (EMG/NCS): This test measures the electrical activity in the nerves and muscles. It may identify if there is nerve damage or nerve compression.

Once a diagnosis has been confirmed, an individual with a herniated disc should be referred to a major spine center for a full evaluation and individual treatment plan.

Treatments for ruptured discs vary, depending on the location and severity of damage. Treatment options are usually quite conservative at first, and can include bed rest, time, acupuncture, over-the-counter pain medications, steroids, muscle relaxants, occupational therapy, and injections. In most cases, the symptoms will resolve within 4-6 weeks.
If these initial treatments are ineffective, other options will be considered. The spine team at the Weill Cornell Brain and Spine believes in an interdisciplinary approach to the treatment of ruptured discs, including physiatry, pain management, physical therapy, and — only when necessary, minimally invasive surgery. For details on surgery for slipped discs, please visit the Weill Cornell Spine Center. (See Surgery for a Herniated Disc.)

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