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Herniated disk


Definition:

A herniated (slipped) disk occurs when all or part of a disk is forced through a weakened part of the disk. This may place pressure on nearby nerves or the spinal cord.

Herniated nucleus pulposus (slipped disk)
Herniated nucleus pulposus (slipped disk)
Alternative Names:

Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk; Herniated nucleus pulposus

Exams and Tests:

A careful physical exam and history is almost always the first step. Depending on where you have symptoms, your doctor examines your neck, shoulder, arms, and hands, or your lower back, hips, legs, and feet.

Your doctor will check:

  • For numbness or loss of feeling
  • Your muscle reflexes, which may be slower or missing
  • Your muscle strength, which may be weaker
  • Your posture, or the way your spine curves

Your doctor may also ask you to:

  • Sit, stand, and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
  • Bend forward, backward, and sideways
  • Move your neck forward, backward, and sideways
  • Raise your shoulders, elbow, wrist, and hand and check your strength during these tasks

Leg pain that occurs when you sit down on an exam table and lift your leg straight up usually suggests a slipped disk in your lower back.

In another test, you will bend your head forward and to the sides while the health care provider puts slight downward pressure on the top of your head. Increased pain or numbness during this test is usually a sign of pressure on a nerve in your neck.

DIAGNOSTIC TESTS

  • Electromyography (EMG) may be done to determine the exact nerve root that is involved.
  • Myelogram may be done to determine the size and location of disk herniation.
  • Nerve conduction velocity test may also be done.
  • Spine MRI or spine CT will show where the herniated disk is pressing on the spinal canal.
  • Spine x-ray may be done to rule out other causes of back or neck pain. However, it is not possible to diagnose a herniated disk by a spine x-ray alone.
Outlook (Prognosis):

Most people improve with treatment. But you may have long-term back pain even after treatment.

It may take several months to a year or more to go back to all of your activities without having pain or straining your back. People who work in jobs that involve heavy lifting or back strain may need to change their job activities to avoid injuring their back again.

Possible Complications:

In rare cases, the following problems can occur:

  • Long-term back pain or leg pain
  • Loss of movement or feeling in the legs or feet
  • Loss of bowel and bladder function
  • Permanent spinal cord injury (very rare)
When to Contact a Medical Professional:

Call your health care provider if:

  • You have severe back pain that does not go away
  • You have any numbness, loss of movement, weakness, or bowel or bladder changes
Prevention:

Being safe at work and play, using proper lifting techniques, and controlling weight may help prevent back injury.

Your health care provider may recommend a back brace to help support the spine. A brace can help prevent injuries in people who lift heavy objects at work. But using these devices too much can weaken the muscles that support your spine and make the problem worse.

References:

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078-93. http://www.ncbi.nlm.nih.gov/pubmed/19363456

Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010;41:217-224. http://www.ncbi.nlm.nih.gov/pubmed/20399360


Review Date: 9/8/2014
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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