Herniated disk: Causes, diagnosis, and treatment

A herniated disk is a common condition that can be painful and debilitating. People also refer to it as a slipped disk or disk prolapse. In some cases, it can lead to pain, numbness, or weakness in the limbs.

However, some people experience no pain, particularly if the disk does not press on any nerves.

Symptoms normally reduce or resolve after a number of weeks, but a person may need surgery if they persist or get worse.

This article will explore the treatment, diagnosis, and prevention of a herniated disk.

Fast facts on herniated disk

A herniated disk occurs in the vertebrae.

Any pain normally resolves within a few months.

Herniated disks might cause few or no symptoms.

Treatments include medication, physical therapy, epidural injections, and surgery.

Treatment

woman with back pain
Herniated disks can range from causing severe pain to no pain at all.

Herniated disks might cause severe pain, but the right treatment can relieve symptoms.

A person can mostly resolve symptoms by avoiding movements that trigger pain and following the exercise and pain medication regimens that a doctor has recommended.

Treatment options include medication, therapy, and surgery.

Medication

Over-the-counter medication (OTC): Ibuprofen- or naproxen-based drugs can help with mild to moderate pain.

Nerve pain medications: Medications for treating nerve pain include gabapentin, pregabalin, duloxetine, and amitriptyline.

Narcotics: If OTC medications do not relieve discomfort, a doctor might prescribe codeine, a combination of oxycodone and acetaminophen, or another type of narcotic. Side effects include nausea, sedation, confusion, and constipation.

Cortisone injections: These can be injected directly into the area of the herniation to help reduce inflammation and pain.

Epidural injections: A doctor injects steroids, anesthetics, and anti-inflammatory medications into the epidural space, which is an area around the spinal cord. This can help minimize pain and swelling in and around the spinal nerve roots.

Muscle relaxants: These help reduce muscle spasms. Dizziness and sedation are common side effects.

Physical therapy

Physical therapists can help find positions and exercises that minimize herniated disk pain.

Therapists may also recommend:

treatment with heat or ice

ultrasound, which uses sound waves to stimulate the affected area and improve blood flow

traction, which can alleviate pressure on the affected nerve

short-term bracing for the neck or lower back, to improve support

electrotherapy, as electric impulses might reduce pain for some people

Surgery

If symptoms do not improve with other treatments, if numbness persists, or if bladder control or mobility worsen, the treating doctor might recommend surgery.

In most cases, the surgeon removes only the protruding portion of the disk. This is an open discectomy.

The surgeon will usually conduct open discectomy using a laparoscopic technique, opening a small hole in either the front or back of the spine.

This technique avoids the need to remove small portions of the vertebrae or to move the spinal nerves and spinal cord to access the disk.

Artificial disk replacement

Surgeons have carried out disk replacement procedures since the 1980s in Europe but are not yet available in the United States.

There are two types. The first is a total disk replacement. The second is a disk nucleus replacement that involves replacing only the soft center of the disk, known as the nucleus.

Artificial disks are metal, biopolymer, or both. A biopolymer is a substance similar to plastic.

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Causes

A slipped disk occurs when the soft internal section of an intervertebral disk protrudes through the outer layer.

The human backbone, or spine, consists of 26 bones called vertebrae. Between each vertebra lie rubbery, cushion-like pads called “disks.” These disks help keep the vertebrae in place and act as shock absorbers.

Spinal disks have a soft, jelly-like center and a tougher exterior.

A herniated disk occurs when some of the soft interior slips out through a crack in the wall of the disk. This most commonly occurs in the low back but can also occur in the vertebrae of the neck.

The escape of this “jelly” is thought to release chemicals that irritate nerves in the surrounding area and cause significant pain. The prolapsed disk may also put pressure on nerves and cause pain through compression.

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