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Herniated (slipped) disc - symptoms, treatment, surgery

 

A herniated disc is a common condition of the spinal column that causes back pain and other symptoms.  It occurs when gel-like substance bulges from a spinal disc, putting pressure on nearby nerves. This condition is often referred to as a slipped disc and sometimes a prolapsed disc. Treatment is likely to include initial rest and rehabilitation which will resolve the majority of herniated discs.  Surgery may be required in some cases.

General information

Between the bones (vertebrae) of your spinal column are discs composed of a tough outer casing (the annulus) with a gel-like centre (the nucleus).  The gel in the discs allows the back to flex and bend, and acts as a shock absorber between the vertebrae. A herniated disc occurs when the annulus of the disc tears and the contents of the disc are pushed out through this tear. The bulging disc material may press on nearby nerves causing pain and affecting function.  A herniated disc is most likely to occur in the lower back (or lumbar spine).

As we age the discs become less flexible and begin to harden, making them more prone to tears.  A herniated disc can be caused by a single excessive strain or injury.  However, as degeneration of the discs progresses with age, some people may suffer herniated discs from more minor exertions or twists.
 

Factors that can increase the likelihood of a herniated disc include:

  • Ageing
  • Being overweight (creating more pressure on the spinal column)
  • Smoking (which can contribute to the degeneration of discs)
  • Incorrect lifting (using the back rather than the legs to lift large heavy objects)
  • Repetitive strenuous activity (many occupations require constant lifting and twisting)
  • Sedentary lifestyle (which can lead to weakening of the muscles that support the spinal column).

The most common age to develop a herniated disc is between 30 and 50 years. Men are affected nearly twice as often as women are.   

In the majority of cases a herniated disc can be treated non-surgically. Surgery may be recommended in severe cases that have not responded to non-surgical treatment.

Signs and symptoms

Some people may have a herniated disc without experiencing any symptoms. Others have severe, debilitating symptoms. The type of symptoms experienced can be influenced by the location of the herniated disc. The most common symptom of a herniated disc is sciatica. This is characterised by a sharp, often shooting pain that extends from the buttocks down the back of one leg, and is caused by pressure on the sciatic nerve. Other symptoms that may be experienced as the result of a herniated disc include:

  • Lower back pain 
  • Leg or arm pain 
  • Abnormal sensations such as tingling, numbness or pins and needles in one arm, one leg or buttock 
  • Burning pain in the shoulders, neck, arm or central back 
  • Muscle weakness.
If problems with bowel or bladder function are experienced this may be a sign of cauda equine syndrome – a rare but serious complication of a herniated disc. Immediate medical attention should be sought if this is suspected.

Diagnosis

In order to make an accurate diagnosis the doctor will need to perform a thorough medical evaluation consisting of a medical history and a physical examination. A referral to an orthopaedic specialist for further assessment and treatment may be recommended. Tests commonly carried out to confirm the diagnosis of a herniated disc include MRI or CT scanning, and x-rays.

If pain continues, nerve conduction studies, which measure nerve impulses to the muscles, may be recommended.   

Non-surgical treatment

Non-surgical treatment involves a combination of initial rest, pain-relieving medication and physiotherapy.

Rest and activity
With the initial onset of pain, bed rest is not usually recommended for more than two days. Longer periods of rest are not effective in speeding recovery and can in fact prolong the recovery time. It is best to continue gentle activity as much as possible while avoiding painful positions or movements.

Medications
Medications commonly prescribed to relieve the pain associated with a herniated disc include paracetamol and non-steroidal anti-inflammatory medications (NSAIDs). Muscle relaxant medications may also be prescribed. In some cases corticosteroid medications may be recommended. These can be given in tablet form or as an injection directly into the affected area. In cases of severe pain where initial treatment has been unsuccessful, pain-relieving medication may be given as an epidural injection – where it is injected into the space around the spinal cord.

Physiotherapy
A combination of physiotherapy treatments and specific exercises will be used to maintain movement and strengthen the muscles in the back. 

Alternative treatments
For some people the use of alternative treatments such as massage, acupuncture, chiropractic and osteopathy prove effective in treating the pain caused by a herniated disc.  

Surgical treatment

If surgery is being considered, it is important to discuss with the doctor the advantages and disadvantages of the surgery as well as the risks involved. Surgical treatment of a herniated disc can include:

Discectomy
This surgery involves removing all or part of the damaged disc in order to relieve pressure on the spinal nerves. A discectomy can be performed as “open” surgery (open discectomy) or “minimally invasive surgery” (microdiscetomy).

Laminectomy
This surgery involves removing parts of the vertebrae, called the lamina, in order to make more room for the spinal nerves, relieving pressure on them and reducing pain.

Spinal Fusion
This surgery involves removing the disc then fusing individual vertebrae together to reduce movement. Spinal fusion stabilises the spine and relieves pressure on the spinal nerves.

Prevention

The following lifestyle changes can help to prevent a herniated disc:

  • Exercising regularly, especially exercises that strengthen the trunk muscles to help support the spine
  • Maintaining good posture, which helps reduce pressure on the spine and discs
  • Lifting heavy objects correctly, ie: using your legs (not your back) and not twisting when lifting
  • Maintaining a healthy weight, as being overweight places more pressure on the spine and discs.

References

O’Toole, M.T. (Ed.) (2013). Herniated disc. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
American Academy of Orthopaedic Surgeons (2012). Orthoinfo: Herniated disc of the lower back (Web Page). Rosemont, IL: American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00534 [Accessed: 15/11/17]
Mayo Clinic (2016). Herniated disc (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. [Accessed: 15/11/17]
 
Last Reviewed – December 2017
 
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