Description

A herniated disk refers to a problem with one of the rubber pads, called disks, which are found between the bones that stack to make the spine. These bones are called vertebrae.

A spinal disc is a soft, jelly-like center called a nucleus. The core is enclosed in a tough, rubbery exterior, known as the ring. A herniated disk occurs when some of the nucleus pushes through a crack in the ring. A herniated disc is sometimes called a slipped disk or a ruptured disk.

A herniated disk, which can occur in any part of the spinal column, often occurs in the lower part of the back. Depending on where the herniated disc, which can cause pain, numbness or weakness in an arm or a leg.

Many people have no symptoms from a herniated disc. For people who have symptoms, the symptoms tend to improve with time. The surgery is usually not necessary to relieve the problem.

Symptoms

Most disc herniations occur in the lower part of the back, but can also occur in the neck. The symptoms depend on where the disc is seated and if the disc is pressing on the nerve. Herniated disc most often affects one side of the body.

  • The arm or leg pain.If the herniated disc in the low back, usually feels pain in the lower back, buttocks, thighs, and calves. You may have pain in one part of your foot. For a herniated disk in the neck, usually felt more pain in his shoulder and arm. This pain can shoot you in the leg or arm when you cough, sneeze, or move in certain positions. The pain is often described as stabbing or burning.
  • Numbness or tingly feeling. People who have a herniated disk, often radiating numbness or tingling in the body part served by the affected nerves.
  • The weakness. The muscles served by the affected nerves tend to weaken. This can cause you to stumble or affect your ability to lift or hold objects.

The arm or leg pain. If the herniated disc in the low back, usually feels pain in the lower back, buttocks, thighs, and calves. You may have pain in one part of your foot.

For a herniated disk in the neck, usually felt more pain in his shoulder and arm. This pain can shoot you in the leg or arm when you cough, sneeze, or move in certain positions. The pain is often described as stabbing or burning.

You may have a herniated disc without symptoms. You might not know you have it unless it appears in a spinal of the image.

When to see a doctor

Seek medical care if your neck or back pain travels down your arm or leg, or if you also have numbness, tingling, or weakness.

Causes

Disc herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As people age, the discs become less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Most people can't identify the cause of their herniated disc. Sometimes, the use of the back muscles instead of your leg and thigh muscles to lift heavy objects may cause a herniated disc. Rotating and twisting while lifting can also cause a herniated disc. Rarely, a traumatic event such as a fall or a blow to the back is the cause.

Risk factors

Factors that may increase the risk of a herniated disk are:

  • Weight. Excess body weight causes extra stress on the discs in the lower back.
  • Of the occupation. People with jobs are physically demanding, have a higher risk of back problems. Repetitive lifting, pulling, pushing, lateral bending and torsion may also increase the risk of a herniated disk.
  • Genetics. Some people inherit a predisposition to develop a herniated disc.
  • The habit of smoking. It is believed that smoking decreases the oxygen supply to the discs, causing them to break down more quickly.
  • Frequent driving. Sitting for long periods of time combined with the vibration of a vehicle's engine can put pressure on the spine.
  • Being sedentary. Regular exercise can help to prevent a herniated disc.

Complications

Above the waist, his spinal cord ends. What follows through the spinal canal is a group of long nerve roots which resembles to a horse's tail, called the cauda equina.

Rarely, herniated disc can compress the entire spinal canal, including all the nerves of the cauda equina. In rare cases, emergency surgery may be needed to avoid permanent weakness or paralysis.

Seek emergency medical attention if you have:

  • Worsening of symptoms. Pain, numbness, or weakness may increase to the point of hindering their daily activities.
  • Bladder or bowel dysfunction. Cauda equina syndrome can cause incontinence or difficulty urinating, even with a full bladder.
  • Saddle anesthesia. This progressive loss of sensitivity affects the areas that would touch a saddle of the inner part of the thighs, the back of the legs and the area around the rectum.

Prevention

To help prevent a herniated disc, do the following:

  • Exercise. The strengthening of the trunk muscles stabilizes and supports the spinal column.
  • Maintain a good posture. This reduces the pressure on the spine and the discs. Keep your back straight and aligned, especially when sitting for long periods. Lift heavy objects correctly, causing your legs, not your back — to-do most of the work.
  • Maintain a healthy weight. Excess weight puts more pressure on the spine and discs, making them more susceptible to herniation.
  • Stop smoking. Avoid the use of any tobacco product.

Diagnosis

During the physical exam, your doctor will check your back for tenderness. You will be asked to lie flat and move your legs into various positions to help determine the cause of your pain.

Your doctor may also perform a neurological exam to check your:

  • Reflections.
  • The muscle strength.
  • The ability to walk.
  • The ability to feel light touches, pinpricks or vibration.

In most cases of herniated disk, a physical exam and a medical history are all that are needed for a diagnosis. If your healthcare provider suspects other condition or need to see which nerves are affected, you may have one or more of the following tests.

Imaging tests

  • The x-ray plain x-rays do not detect a herniated disc, but it can rule out other causes of back pain. The X-ray may show an infection, a tumor, spinal alignment problems or a broken bone.
  • CTscan. A ct scanner takes a series of X-rays from different directions. These images are combined to create cross-sectional images of the spine, and the structures around it.
  • The magnetic resonance imaging. The Radio waves and a strong magnetic field are used to create images of the internal structures. This test can be used to confirm the location of the herniated disc and see which nerves are affected.
  • A myelogram. A dye is injected into the cerebrospinal fluid before a ct scan is done. This test can show the pressure on the spinal cord or the nerves due to herniated disc or other conditions.

Nerve tests

Nerve conduction studies and electromyogram (Emg) to measure the degree of electrical impulses that travel along nerve tissue. This can help to identify the location of nerve damage.

  • The nerve conduction study. This test measures electrical nerve impulses and functioning of the muscles and nerves through electrodes placed on the skin. The study measures the electrical impulses in the nerve signals when a small current passes through the nerve.
  • Electromyogram (EMG). During an EMG , a doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of the muscles when to contract and when it is at rest.

Treatment

The conservative treatment includes changing activities to stay away from movement that causes pain and taking pain medication. This treatment relieves symptoms in most people within a couple of days or weeks.

Drugs

  • No prescription drugs for the pain. If the pain is mild to moderate, your doctor may recommend non-prescription medication for the pain. The options include acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
  • Neuropathic drugs. These drugs affect the nervous impulses to decrease pain. They include gabapentin (Horizant, Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), or venlafaxine (Effexor XR).
  • Muscle relaxants. You may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects.
  • Opioids. Due to the side effects of opioids and the potential for addiction, many health care professionals hesitate to prescribe them for herniated disc. If other medicines do not relieve your pain, your health care professional may consider the short-term use of opioids. Codeine or oxycodone-acetaminophen combination (Percocet) can be used. Sedation, nausea, confusion and constipation are the possible side effects of these medications.
  • Injections of cortisone. If the pain does not improve with oral medications, your health care professional may recommend a corticosteroid injection. This medicine may be injected in the area around the spinal nerves. Spinal imaging may help guide the needle.

Therapy

Your health care team may suggest physical therapy to help with the pain. Physical therapists can show positions and exercises that are designed to minimize the pain of a herniated disk.

Surgery

Few people with a herniated disc require surgery. If conservative treatments fail to improve your symptoms after six weeks, surgery may be an option, especially if you follow:

  • The poor control of pain.
  • Numbness, or weakness.
  • Difficulty standing or walking.
  • Loss of bladder or bowel control.

In almost all cases, surgeons can remove only the portion that protrudes from the disc. Rarely, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with a bone graft.

To allow the process of bone fusion, which takes months, hardware of metal is placed in the spine to provide spinal stability. Rarely, the surgeon may suggest the implantation of an artificial disc.

Lifestyle and home remedies

In addition to taking the medicines for the pain to your health care professional recommends that the case of:

  • The application of heat or cold. In the first place, cold compresses can be used to relieve pain and swelling. After a couple of days, you can switch to gentle heat to give relief and comfort.
  • Avoid the excess of a lot of bed rest. Stay in bed can lead to stiffness in the joints and muscle weakness, which may complicate their recovery. In its place, resting in a position of comfort for 30 minutes, and then go for a walk or do some work. Try to avoid activities that worsen the pain.
  • The resumption of the activity slowly. Let your pain guide you to the resumption of its activities. Make sure your movements are slow and controlled, especially when you lean forward and lift.

Alternative medicine

Some alternative medicine and complementary treatments can help relieve the chronic back pain. Examples include:

  • Chiropractic. Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.
  • Acupuncture. Although the results are generally modest, the acupuncture seems to ease chronic back and neck pain.
  • The massage. This hands-on therapy can provide short-term relief for people dealing with chronic low back pain.

Preparing for your appointment

It is likely to start by seeing your family health care provider. You may be referred to a specialist in physical medicine and rehabilitation, orthopedics, surgery, neurology, or neurosurgery.

What you can do

Before your appointment, you must be prepared to answer the following questions:

  • When did the symptoms begin?
  • It is to lift, push or pull of anything in the moment in which he felt the symptoms? Is that a twist in the back?
  • The pain prevented him from taking part in the activities?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What medications or supplements you take?

What to expect from your doctor

Your health care team may ask other questions, including:

  • The pain of travel in your arms or legs?
  • Do you feel weakness or numbness in the arms or legs?
  • Have you noticed changes in your bowel or bladder habits?
  • Makes you cough or sneeze worsen your pain?
  • Is the pain interferes with your sleep or work?
  • Does your work involve lifting heavy objects?
  • Do you smoke or use other tobacco products?
  • How has your weight changed recently?
Symptoms and treatment of disc Herniation