What is a herniated disc?

A herniated disc occurs when a disc in the spine is damaged and breaks or bulges through a tear in the tough exterior. The vertebrae of your spine are cushioned by these spongy discs that act as shock absorbers.

A herniated disc is also called a “slipped disc” or “ruptured disc” and can aggravate nerves nearby, causing pain, weakness or numbness in the arms or legs.

A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in the arms or legs. Although most herniated discs occur in the lumbar spine (lower back), some occur in the cervical spine (neck) or thoracic spine (upper back). Most people who suffer from a herniated disc can heal with nonsurgical treatments.

Causes of herniated disc

A herniated disc is most frequently caused by wear on the disc or injuries to the spine.
  • Disc degeneration — as people age, their discs aren’t as flexible and can dry up.
  • Trauma — injuries to the spine can cause cracks or tears in the tough, outer layer of the disc. Discs can bulge or break open through these tears or cracks.
  • Falls or blows — hard falls or blows to the back could cause a disc to herniate.
  • Lifting — lifting heavy objects with your back.

Risk factors for herniated disc

  • Age — people over the age of 35 and under 50 are more likely to rupture a disc than other age ranges.
  • Weight — overweight people are at higher risk of suffering from a herniated disc.
  • Career — careers that require demanding, repetitive work or lifting heavy objects.
  • Gender — men are more than twice as likely to suffer from a herniated disc.
  • Genetics — a family history of herniated discs can put you higher risk of a future herniated disc.

Symptoms of herniated disc

Symptoms of a herniated disc depend on where the disc has ruptured. The most common symptom of a herniated disc in the lower back is pain in the buttocks, thigh, calf or foot. If the disc herniated in the neck, pain is worse in the arm and shoulder. The pain can shoot down the arms or legs when you move or cough.

Other symptoms of a herniated disc include:
  • Numbness or tingling in the affected area of the body
  • Weakness in the muscles that are served by the affected nerves
  • Some people may stumble or be unable to move the affected limbs
Some people never experience any of the symptoms of a herniated disc.

Diagnosis of herniated disc

A herniated disc can typically be diagnosed by your primary care doctor after a full exam.

Medical history
In the full medical history, the physician will ask questions such as type of pain, previous medical conditions, career choice, medical history and family medical history.

Physical Exam
During the physical exam, your physician will test for your ability to walk, muscle strength, reflexes or ability to feel light pinpricks.

Diagnostic testing
In some cases, an X-ray, CT scan, MRI or myelogram may be ordered.

  • X-rays —can’t detect herniated discs, but can be used to rule out infections, tumors or other spinal issues.
  • CT scan — can provide more detailed images and show multiple views that can help diagnose a lumbar herniated disc.
  • MRI — can detect the exact location of the herniated disc and determine if nerves are affected.
  • Myelogram — an x-ray is taken after dye is injected into the spinal fluid to determine if there is pressure on the spine due to herniated discs or other conditions.

Treatments for herniated disc

Most patients heal from a herniated disc on their own. To alleviate the pain, you should follow these recommendations:
  • Stay active — long periods of inactivity can weaken the muscles and make the condition worse.
  • Rest — rest if you have severe pain; when the pain subsides, resume activity.
  • Anti-inflammatory medication — take an anti-inflammatory medication.
  • Heat compresses — keep the area warm either in a hot shower or with a heating pad. Alternate with icing the area.

Your doctor may recommend a steroid (epidural) injection or physical therapy for certain cases.

  • Injection — an epidural injection can relieve the pain associated with a herniated disc, though pain relief is only temporary.
  • Physical therapy — your physician may prescribe physical therapy to help rehabilitate your back. The physical therapists will work with you to teach you safe ways to perform everyday activities.
If your pain does subside within six to eight weeks, you may need to have surgery to repair the ruptured disc. If you have the following symptoms after six weeks, please contact your physician to discuss surgical treatments:
  • Loss of bowels or bladder control
  • Severe pain that prohibits you from performing day-to-day activities
  • Weakness or numbness that is progressively getting worse
  • Nonsurgical treatments are not working
Surgery is most frequently indicated for a lumbar herniated disc.
Types of surgery include:

Discectomy
A discectomy is the surgical removal of the herniated disc contents that are putting pressure on the spinal cord. For a lumbar herniated disc, microdiscectomy or endoscopic microdiscectomies are the most common procedures. Typically, only a small portion of the disc will need to be removed, and most of the disc can remain intact.

Anterior cervical discectomy & fusion (ACDF)
This is a surgical procedure that is used to treat a herniated disc that is compressing the spinal cord or nerve roots. In this procedure, the surgeon will decompress the cervical spine with a discectomy. A discectomy will stabilize the corresponding vertebrae.

Surgical Spinal Decompression
Spinal decompression is a procedure used for bulging or ruptured disks, any bony growths, or other spinal problems. Surgery may help relieve symptoms from pressure on the spinal cord or nerves caused by the herniated disc.

Recovery from a herniated disc

Most people will recover from a herniated disc within three months after surgery. If the pain and symptoms have not subsided, there may be another injury that is impacting the area. Physical therapy should be continued during the recovery process, as well as while the physician determines if there is an alternate reason why the back is in pain.

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