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

See also:

• Acute low back pain
• Chronic low back pain
• Sciatica

Herniated nucleus pulposus (slipped disk)

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

A careful physical exam and history is almost always the first step. Depending on where you have symptoms, your doctor will examine 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

• 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 that 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.

Most people will improve with treatment. However, you may have 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.

• 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)

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

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

Some health care providers recommend the use of back braces to help support the spine. Such braces can help prevent injuries in people who have to lift heavy objects at work. However, using these devices too much can weaken the abdominal and back muscles, making the problem worse.

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Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010;41:217-224.

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. Review.