EVERYTHING YOU NEED TO KNOW ABOUT A SLIPPED DISC
A common source of back or neck pain is a herniated disc, which is sometimes called a “ruptured” or “slipped” disc.
Discs are soft, rubbery pads located between the bones, or vertebrae that make up the spine. There are 33 vertebral bones that interlock, and 23 discs. The 33 vertebrae are divided into 3 main sections: the cervical, the thoracic, and the lumbar. Below the lumbar region there is the sacrum and coccyx that are a group of 9 fused-together bones.
The discs between the vertebrae stop the bones from rubbing together and allow the back to flex or bend. Discs in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the disks are similar but smaller in size. Discs act like coiled springs, allowing frictionless movement in your spine. Think of them as your own shock absorbers.
A disk herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the nerves, which can cause pain, numbness, or weakness.
The most common area affected is the lumbar region because it is the weight-bearing part of the spine. Above 90% of herniations occur in L4-L5 or L5-L6. [See a study by C.J Donnally 111 and others.]
The most common symptom of a herniated disc in the lower back is sciatica. Other symptoms include:
- Back pain
- Weakness in the leg and/or foot
- Tingling (a “pins-and-needles” sensation) or numbness in the leg and/or foot
- Loss of bladder or bowel control (This is rare and may indicate a more serious problem called cauda equina syndrome, which requires immediate medical attention.)
Neck pain is a common symptom of a herniated disc in the neck, similar to pain the lower back. When pressure is placed on a nerve in the neck, or cervical region of the spine, it causes pain the muscles between the neck and shoulder with radiating pain down into the arm. Other symptoms include:
- Weakness in one arm
- Tingling (a “pins-and-needles” sensation) or numbness in one arm
- Burning pain in the shoulders, neck, or arm
Nonsurgical treatment is effective in treating the symptoms of herniated discs in most patients. Most neck or back pain will resolve gradually with conservative measures:
- Rest and slow and controlled physical activity
- Non-steroidal anti-inflammatory medications such as Ibuprofen, Naproxen, or Diclofenac
- Ice and heat treatment
- Physical Therapy: For the lower back, exercises may also be helpful in strengthening the back and abdominal muscles. For the neck, exercises or traction may also be helpful.
- Epidural injections may lessen nerve irritation if other nonsurgical treatments fail to provide relief
Only a small percentage of patients with slipped discs require surgery and is typically recommended only after nonsurgical treatment has not relieved symptoms.
The most common procedure for a lumbar herniation is a lumbar microdiscectomy. The procedure involves removing the herniated part of the disc and any fragments that are putting pressure on the spinal nerve. The technique of microdiscectomy was first introduced by Yasargil and Caspar independently. In some cases, the entire disc may need to be removed.
Cervical discectomy is a procedure for a herniated disc in the neck. To relieve pressure, the entire slipped disc is removed and bone is placed in the disc space along with a metal plate to help support the spine.
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