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by Scholten A

Herniated Disc

(Herniation of Nucleus Pulposus [HNP]; Prolapsed Disc; Ruptured Disc; Slipped Disc)

Definition

A herniated disc is a bulging of one of the small, round discs between the vertebral bones of the spine. Discs act as cushions for the vertebra. A disc that bulges from its proper place puts pressure on spinal nerves.
Herniated Lumbar Disc
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Causes

Common causes are:
  • The natural aging process (most common cause)
  • Genetics
  • Poor posture and body mechanics
  • Too much pressure on the spine, such as from an inactive lifestyle
  • Recent trauma, such as a fall or motor vehicle accident

Risk Factors

This problem is more common in older adults. Other things that may raise the risk are:
  • Obesity
  • A history of low back pain
  • Long periods of standing and bending forward
  • Smoking
  • Strenuous activities, such as heavy lifting
  • Genetic problems related to discs

Symptoms

Problems are more common in the lower spine. The main symptom is pain that may:
  • Be sharp, dull, piercing, aching, burning, or throbbing
  • May spread over the back, buttocks, down the back of one thigh, and into the calf
  • Be in one leg or both legs
Other problems may be:
  • Numbness, tingling, or weakness in the legs, feet, or in one or both arms
  • A sudden aching or twisted neck that cannot be straightened without feeling pain
  • Numbness in the groin (rare)
  • Bowel or bladder changes (rare)

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. It will focus on the spine.
Images may be taken of the spine. This can be done with:

Treatment

Most people start to feel better in a few days or weeks. Staying active may be better than full rest.
The goal of treatment is to manage symptoms. Choices are:
  • Supportive care, such as not sitting for long periods of time, avoiding things that cause pain, and using cold or warm compresses
  • Physical therapy to promote strength, flexibility, and range of motion
  • Medicines, such as:
    • Over-the-counter or prescription pain relievers
    • Steroid injections to ease pain and swelling
People who are not helped by these methods may need surgery. Choices are:
  • Laminectomy to remove some of the bone over the spine and problem disc
  • Microdiscectomy to remove fragments of herniated disc through a small incision
  • Spinal fusion to fuse vertebrae together with bone grafts or metal rods (rare)

Prevention

There are no known guidelines to prevent this health problem.

RESOURCES

North American Spine Society
http://www.spine.org
Ortho Info—American Academy of Orthopaedic Surgeons
http://www.orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References

Deyo RA, Mirza SK. CLINICAL PRACTICE. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016 May 5;374(18):1763-1772.
Herniated disk in the lower back. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back. Accessed February 17, 2021.
Lumbar disk herniation. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/lumbar-disk-herniation. Accessed February 17, 2021.

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