Herniated Disk (Slipped Disk)

Spine

Herniated Disk (Slipped Disk)

A herniated disc, also commonly called a slipped disc, is a condition in which the soft, gel-like center (nucleus pulposus) of an intervertebral disc protrudes or bulges outward through a tear in the tough outer covering (annulus fibrosus). These intervertebral discs act as cushions and shock absorbers between the vertebrae of your spine, providing flexibility and support during movement. When a herniated disc occurs, the protruding material can put pressure on nearby nerves, causing pain, numbness, weakness, and other symptoms depending on the location of the herniation.

What are the Symptoms?

Pain: This is usually the most important symptom, often described as a sharp, stabbing pain radiating from the lower back (lumbar hernia) or neck (cervical hernia) down to the leg or arm, respectively, following a specific nerve pathway. The pain may worsen with certain movements, such as coughing, sneezing, or straining.
Numbness or tingling: Individuals may experience numbness, tingling, or weakness in the muscles served by the compressed nerve. This can affect the leg or arm, depending on the location of the hernia.
Muscle weakness: The muscles served by the compressed nerve may feel weak, making it difficult to perform activities such as lifting objects, climbing stairs, or walking.
Sciatica: A herniated disc in the lower back (lumbar spine) can compress the sciatic nerve, causing pain radiating down the buttocks and leg, often described as a burning or shooting pain.

What are the Causes & Risk Factor?

Common causes and risk factors for herniated discs include:

Age-related degeneration: As we age, intervertebral discs naturally lose their water content and become less flexible, making them more susceptible to tears.
Improper lifting techniques: Lifting heavy objects with poor posture or using your back instead of your legs can put excessive pressure on the spine, increasing the risk of a herniated disc.
Sudden, violent movements: Activities involving sudden twisting or bending, such as falling or lifting heavy objects with improper technique, can cause a tear in the annulus fibrosus.
Repetitive stress: Jobs or activities that involve sitting, bending, twisting, or lifting objects for a prolonged period of time can put repetitive strain on the spine and discs, eventually leading to a herniation.
Obesity: Excess weight puts additional pressure on the spine, including the intervertebral discs.
Smoking: Smoking can weaken the annulus fibrosus and decrease blood flow to the discs, contributing to degeneration and increasing the risk of herniation.
Genetic predisposition: Some people may have a genetic predisposition to weaker connective tissues, making them more susceptible to herniated discs.

Predisposing factors for herniated discs

Although anyone can develop a herniated disc, certain factors can increase your susceptibility:

Occupations requiring frequent heavy lifting or awkward postures: People whose job involves lifting heavy objects, sitting for long periods of time, or awkward postures such as truck drivers, construction workers

Weak core muscles: Weak core muscles can lead to poor posture and put additional strain on the lower back, increasing the risk of herniation.

Previous back injuries: Individuals with a history of back injuries or sprains are more susceptible to future disk herniations due to weakened tissues.

Diagnosis of Herniated discs

Physical Examination

During a physical exam, your healthcare professional checks your back for tenderness.
In most cases of herniated disc, a physical examination and medical history are sufficient to make the diagnosis.

Imaging tests

X-rays: Although plain X-rays do not directly detect herniated discs, they can rule out other causes of back pain (for example, infections, tumors, spinal alignment problems, or broken bones).

CT scan: A CT scanner combines X-rays from different directions to create cross-sectional images of the spinal column and surrounding structures.

MRI: Radio waves and a strong magnetic field create detailed images of the body's internal structures. MRI confirms the location of the herniated disc and identifies the affected nerve.

Myelogram: A dye is injected into the spinal cord before a CT scan to show pressure from multiple herniated discs or other conditions on the spinal cord or nerves.

Neurological test

Nerve conduction studies and electromyograms (EMGs) measure how well electrical impulses travel along nerve tissue. These tests help identify the location of nerve damage.

Treatment Options for Herniated Disks

The good news is that most herniated disks improve with conservative treatment within a few weeks or months. Treatment typically involves a multimodal approach, focusing on pain management, reducing inflammation, and promoting healing.

Conservative Management

Rest: While complete bed rest is not usually recommended, avoiding strenuous activities that exacerbate pain can be beneficial in the initial phase of recovery.
Pain medication: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and discomfort. In some cases, stronger pain medication might be prescribed by a healthcare professional.
Physical therapy: Physical therapy plays a crucial role in managing herniated disks. Manual therapy techniques like massage therapy and joint mobilization can help manage pain, improve mobility, and reduce muscle tension.
Heat or ice therapy: Applying heat or ice packs to the affected area can help reduce inflammation and pain.
Lifestyle modifications: Maintaining a healthy weight, engaging in regular physical activity (excluding activities that exacerbate pain), and practicing good posture can all contribute to managing herniated disks and preventing future occurrences.

Injections

Epidural steroid injections: These injections deliver corticosteroids directly into the epidural space, the area surrounding the spinal cord and nerve roots. Corticosteroids can help reduce inflammation and pain around the compressed nerve.

Minimally Invasive Procedures

In some cases, if conservative approaches fail to provide adequate pain relief after several weeks, minimally invasive procedures might be considered:
Selective nerve root blocks injections deliver a local anesthetic and sometimes a corticosteroid directly to the affected nerve root, providing targeted pain relief.

Surgery

Herniated disk surgery is typically a last resort for individuals with severe and persistent pain that significantly impacts their daily life and has not responded to conservative or minimally invasive treatments. The most common surgical procedures for herniated disks include:
Microdiscectomy: This minimally invasive surgery involves removing the herniated portion of the disk through a small incision.
Discectomy and fusion: This surgery involves removing the herniated portion of the disk and fusing the vertebrae together with bone grafts or implants to prevent future herniations.

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