Herniated Disc
En Español (Spanish Version)

Definition
Discs are small circular, compressible cushions between the vertebral bones in the spinal column. They act as cushions for the vertebrae. A herniated disc bulges from its proper place, putting pressure on spinal nerves. This is most common in the lower spine.

Herniated Lumbar Disc

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Causes
A herniated disc is caused by reduced water content, which results in flattening and less cushioning. It can also be the result of trauma.

Risk Factors
A herniated disc is generally associated with normal aging. It is more common in people after age 30 years of age. Other factors that may increase your chance of a herniated disc include:

  • 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
  • Smoking
  • Obesity
  • Diabetes
Symptoms
A herniated disc may cause:

  • Pain
    • May be sharp, dull, piercing, aching, burning, or throbbing, depending on the disc and size of herniation
    • May spread over the back, buttocks, down the back of one thigh, and into the calf
    • May be in one leg or both legs
  • Numbness, tingling, or weakness in the legs, feet, or 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 for emergency medical services right away.
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your spine will be examined. The movement, strength, and reflexes of your arms and legs will be tested.

Images may be taken of your bodily structures. This can be done with:

Treatment
Staying active may be better than bed rest. Treatments may include:

Physical Therapy
The following therapies may be used:

  • Back or neck massage and physical therapy to:
    • Relax the neck or back muscles
    • Decrease pain
    • Increase strength and mobility
  • Back and abdominal exercises
  • Hot or cold packs to reduce pain and muscle spasms
  • Chiropractic care
  • Using weights and pulleys to relieve pressure on the discs and keep you from moving around
  • A neck collar or brace for a herniated disc in the neck to relieve muscle spasms
Medications
Your doctor may advise:

  • Over-the-counter or prescription pain relievers
  • Muscle relaxants to reduce muscle spasms
Interventional Spine Care
Interventional spine care treatments may include:

  • Steroid injections into the area around the nerve and disc 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
Surgery may be used for people who fail to respond to other treatments. Immediate surgery is necessary for cauda equina syndrome. Options include:

  • Laminectomy—removal of some of the bone over the spine and of the problem disc
  • Microdiscectomy—removal of fragments of herniated disc through a small incision; this procedure is also known as intervertebral discectomy
  • Spinal fusion—fusing of vertebrae together with bone grafts or metal rods; this is rarely done for first-time disc problems
Prevention
To help reduce your chance of a herniated disc:

  • 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:
North American Spine Society

Ortho Info—American Academy of Orthopaedic Surgeons

CANADIAN RESOURCES:
Canadian Orthopaedic Association

Canadian Orthopaedic Foundation

References:
Awad JN, Moskovich R. Lumbar disc herniations: Surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:183-197.

Humphreys CS. Clinical evaluation and treatment options for herniated lumbar disc. Am Fam Physician. 1999;59(3):575-582.

Lumbar disk herniation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 26, 2014. Accessed December 18, 2014.

Last Reviewed December 2014



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