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Herniated (slipped) disc - symptoms, treatment, surgery

 

A herniated disc is a common condition of the spine 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. Initial treatment is usually rest and recovery, which will resolve the majority of herniated discs. Surgery may be required in some cases.

Causes and risk factors

Between the bones (vertebrae) of your spinal column are discs made of a tough outer casing with a gel-like centre. The gel in the discs allows the back to flex and bend, and acts as a shock absorber between the vertebrae. 

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. 

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. A herniated disc is most likely to occur in the lower back (or lumbar spine). 

The most common symptom of a herniated disc is sciatica. This is often a sharp, shooting pain that extends from the buttocks down the back of one leg. Sciatica 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 equina syndrome — a rare but serious complication of a herniated disc. Immediate medical attention should be sought if this is suspected.

Diagnosis

Tests commonly carried out to confirm the diagnosis of a herniated disc include magnetic resonance imaging (MRI) or computed tomography (CT) scanning, and x-rays. 

A myelogram, in which dye is injected into the fluid around the spine before x-rays are taken, can show pressure on the spinal cord or nerves due to a herniated disc.
Nerve conduction studies, which measure nerve impulses to the muscles, may also be recommended. 

Non-surgical treatment

Initial treatment for a herniated disc usually involves a combination of rest, pain-relieving medication, and/or physiotherapy.

  • Rest versus 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 prolong the recovery time. It is best to continue gentle activity as much as possible while avoiding painful positions or movements.
  • Applying cold or heat: When symptoms are first felt, applying a cold pack may relieve pain and inflammation. After a few days, applying gentle heat to the affected area may provide pain relief.
  • Medications: Medications commonly prescribed to relieve the pain associated with a herniated disc include paracetamol and ibuprofen. Muscle relaxant medications may also be prescribed for muscle spasms. In some cases, corticosteroid tablets or injections may be recommended. For severe pain where initial treatment has been unsuccessful, a mixture of steroids and anaesthetic may be injected directly into the spine area.
  • Physiotherapy: A combination of physiotherapy treatments and specific exercises will be used to maintain movement and strengthen the muscles in the back. 

Surgical treatment

Surgery may be recommended if non-surgical treatment is unsuccessful in reducing or stopping the pain. 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: Involves removing all or part of the damaged disc to relieve pressure on the spinal nerves. A discectomy can be performed as “open” surgery (open discectomy) or “minimally invasive surgery” (microdiscetomy).
  • Laminectomy: Involves removing parts of the vertebrae, called the lamina, to make more room for the spinal nerves, relieving pressure on them and reducing pain.
  • Spinal fusion: 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 back, pelvic and abdominal 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.
  • Quit smoking.

References

American Academy of Orthopaedic Surgeons (2018). Orthoinfo: Herniated disc of the lower back (Web Page). Rosemont, IL: American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back [Accessed: 13/11/20]
Mayo Clinic (2019). Herniated disc (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095 [Accessed: 13/11/20]
O’Toole, M.T. (Ed.) (2017). Herniated disc. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last Reviewed: November 2020

 
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