Intervertebral discs separate each of the bones of the spinal column with the exception of the first vertebra in the neck. The discs act as shock absorbers to minimize the impact of movement on the spine. Their structure resembles that of a jelly donut with a soft central portion (nucleus pulposus) surrounded by a tough, flexible outer ring (annulus fibrosus).
A herniated disc sometimes referred to as a slipped, bulging, or ruptured disc, can occur as the result of the stress of long-term wear and tear or develop as a consequence of a sudden injury. When a disc herniates, the softer central portion ruptures and pushes out through a crack in the surrounding outer ring.
A herniated disc can irritate nearby nerves and cause symptoms of pain, numbness, tingling, or weakness. The part of the body where the symptoms develop depends upon the location of the herniated disc. When a disc herniates in the upper back area, neck pain and radiating symptoms through the shoulder and arm can develop. In the case of a lower back disc herniation, symptoms may radiate to buttocks and down through the legs. However some individuals who display evidence of a disc herniation in diagnostic tests, do not exhibit symptoms.
The most common area for a herniated disc to occur is in the lower back between the fourth and fifth lumbar vertebrae. This area is particularly susceptible as it bears the weight of the upper body and the brunt of physical stresses generated by daily activities. Factors that may increase the risk of a herniated disc include excessive weight, physically demanding activities that strain the spine, a sedentary lifestyle, and smoking.
The diagnosis of a herniated disc begins with a complete medical history and physical examination. Based on the symptoms present the doctor will examine the spine and conduct a neurological examination including checking for pain, weakness, and sensory loss. Further testing may be suggested to confirm the diagnosis, determine the location of the herniated disc, and to rule out other conditions.
Unless there are significant neurological deficits including difficulty walking, standing or a loss of bladder and bowel control, conservative care for a herniated disc is usually the first course of treatment. Common non-surgical measures may include rest (as recommended), physical therapy, muscle-relaxant medications, pain medications, anti-inflammatory medications, and steroid injections. When conservative treatment does not relieve the symptoms, or if they have worsened, surgery may be recommended. The doctor will discuss the appropriate surgical procedures to remove the offending portion of the herniated disc based on the individual situation and the condition of the spine around the affected disc.