Degenerative disk disease (Herniated disk) refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine.
A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer \"jelly\" pushes out through a crack in the tougher exterior.
A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don't need surgery to correct the problem.
SYMPTOMS
You can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem. But some herniated disks can be painful. Most herniated disks occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine).
The most common signs and symptoms of a herniated disk are:
Arm or leg pain. If your herniated disk is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
CAUSES
Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.
Most people can't pinpoint the exact cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.
COMPLICATIONS
Your spinal cord doesn't extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse's tail. Rarely, disk herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.
Seek emergency medical attention if you have:
Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.
DIAGNOSIS
During the physical exam, your doctor will check your back for tenderness. He or she may ask you 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:
Reflexes Muscle strength,Walking ability,Ability to feel light touches, pinpricks or vibration
In most cases of herniated disk, a physical exam and a medical history are all that's needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.
Imaging tests
X-rays. Plain X-rays don't detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.Computerized tomography (CT scan). A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.Magnetic resonance imaging (MRI). Radio waves and a strong magnetic field are used to create images of your body's internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected. Myelogram, a dye is injected into the spinal fluid, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
Nerve tests
Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.
TREATMENT
Conservative treatment — mainly avoiding painful positions and following a planned exercise and pain-medication regimen — relieves symptoms in 9 out of 10 people with a herniated disk.
Medications
Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).Narcotics. If your pain doesn't improve with over-the-counter medications, your doctor may prescribe narcotics, such as codeine or an oxycodone-acetaminophen combination (Percocet, Oxycontin, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs.Nerve pain medications. Drugs such as gabapentin (Neurontin, Gralise, Horizant), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Ultram) and amitriptyline often help relieve nerve-damage pain. Because these drugs have a milder set of side effects than do narcotic medications, they're increasingly being used as first line prescription medications for people who have herniated disks.Muscle relaxers. Muscle relaxants may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects of these medications.Cortisone injections. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves. Spinal imaging can help guide the needle more safely. Occasionally a course of oral steroids may be tried to reduce swelling and inflammation.
Therapy
Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk. A physical therapist may also recommend:
Heat or ice Traction, Ultrasound,Electrical stimulation, Short-term bracing for the neck or lower back
Surgery
A very small number of people with herniated disks eventually need surgery. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to experience:
Numbness or weakness, Difficulty standing or walking, Loss of bladder or bowel control
In many cases, surgeons can remove just the protruding portion of the disk. Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Rarely, your surgeon may suggest the implantation of an artificial disk.
A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer \"jelly\" pushes out through a crack in the tougher exterior.
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| Degenerative disk disease (Herniated disk) |
A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don't need surgery to correct the problem.
SYMPTOMS
You can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem. But some herniated disks can be painful. Most herniated disks occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine).
The most common signs and symptoms of a herniated disk are:
Arm or leg pain. If your herniated disk is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
CAUSES
Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.
Most people can't pinpoint the exact cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.
COMPLICATIONS
Your spinal cord doesn't extend into the lower portion of your spinal canal. Just below your waist, the spinal cord separates into a group of long nerve roots (cauda equina) that resemble a horse's tail. Rarely, disk herniation can compress the entire cauda equina. Emergency surgery may be required to avoid permanent weakness or paralysis.
Seek emergency medical attention if you have:
Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.
DIAGNOSIS
During the physical exam, your doctor will check your back for tenderness. He or she may ask you 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:
Reflexes Muscle strength,Walking ability,Ability to feel light touches, pinpricks or vibration
In most cases of herniated disk, a physical exam and a medical history are all that's needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.
Imaging tests
X-rays. Plain X-rays don't detect herniated disks, but they may be performed to rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.Computerized tomography (CT scan). A CT scanner takes a series of X-rays from many different directions and then combines them to create cross-sectional images of your spinal column and the structures around it.Magnetic resonance imaging (MRI). Radio waves and a strong magnetic field are used to create images of your body's internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected. Myelogram, a dye is injected into the spinal fluid, and then X-rays are taken. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
Nerve tests
Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.
TREATMENT
Conservative treatment — mainly avoiding painful positions and following a planned exercise and pain-medication regimen — relieves symptoms in 9 out of 10 people with a herniated disk.
Medications
Over-the-counter pain medications. If your pain is mild to moderate, your doctor may tell you to take an over-the-counter pain medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).Narcotics. If your pain doesn't improve with over-the-counter medications, your doctor may prescribe narcotics, such as codeine or an oxycodone-acetaminophen combination (Percocet, Oxycontin, others), for a short time. Sedation, nausea, confusion and constipation are possible side effects from these drugs.Nerve pain medications. Drugs such as gabapentin (Neurontin, Gralise, Horizant), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Ultram) and amitriptyline often help relieve nerve-damage pain. Because these drugs have a milder set of side effects than do narcotic medications, they're increasingly being used as first line prescription medications for people who have herniated disks.Muscle relaxers. Muscle relaxants may be prescribed if you have muscle spasms. Sedation and dizziness are common side effects of these medications.Cortisone injections. Inflammation-suppressing corticosteroids may be given by injection directly into the area around the spinal nerves. Spinal imaging can help guide the needle more safely. Occasionally a course of oral steroids may be tried to reduce swelling and inflammation.
Therapy
Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk. A physical therapist may also recommend:
Heat or ice Traction, Ultrasound,Electrical stimulation, Short-term bracing for the neck or lower back
Surgery
A very small number of people with herniated disks eventually need surgery. Your doctor may suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to experience:
Numbness or weakness, Difficulty standing or walking, Loss of bladder or bowel control
In many cases, surgeons can remove just the protruding portion of the disk. Rarely, however, the entire disk must be removed. In these cases, the vertebrae may need to be fused together with metal hardware to provide spinal stability. Rarely, your surgeon may suggest the implantation of an artificial disk.
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