Disk Herniation

“A herniated (slipped) disk occurs when all or part of a disk in the spine is forced through a weakened part of the disk. This may place pressure on nearby nerves” (Medline Plus). The lower back (lumbar area) of the spine is the most common area for a slipped disk. The neck (cervical) disks are affected a small percentage of the time. The upper-to-mid-back (thoracic) disks are rarely involved.

Symptoms

The symptoms that are indicative of herniated disk include a low back or neck pain that tingles mildly. You could feel a dull ache, burning or a pulsating pain. Numbness and inability to move are experienced in some cases. The pain is said to occur mostly on one side of the body.

Lower back

If the lower back is affected, there is usually sharp pain in one part of the leg, hip, or buttocks and numbness in other parts. The affected leg will experience weakness and there is pain or numbness on the back of the calf or sole of the foot.

Neck

If the slipped disk is in the neck, it will be painful to move the neck and there will be a deep pain near or over the shoulder blade. The pain usually moves to the upper arm, forearm but rarely to fingers. Numbness is present along the shoulder, elbow, forearm, and fingers. The pain usually starts slowly and may worsen after standing or sitting and during the night. Sneezing, coughing, and laughing can aggravate the pain. The pain becomes worse when bending backwards or when walking for some distance. Some of the other symptoms are only known during a medical examination. It is best to consult a doctor as soon as possible. Medline Plus claims that the pain, numbness, or weakness will often go away or improve a lot over a period of weeks to months.

Causes

According to Medline Plus, slipped disks occur more often in middle-aged and older men, usually after strenuous activity. Other risk factors include conditions present at birth (congenital) that affect the size of the lumbar spinal canal. “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. This makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist” (Mayo Clinic). Moreover, fall and a blow to the back rarely cause herniated disk. The bones (vertebrae) of the spinal column protect nerves that come out of the brain and travel down your back to form the spinal cord. Nerve roots are large nerves that branch out from the spinal cord and leave your spinal column between each vertebra. The spinal bones are separated by disks. These disks cushion the spinal column and put space between your vertebrae. The disks allow movement between the vertebrae, which lets you bend and reach. These disks may move out of place (herniate) or break open (rupture) from injury or strain. When this happens, there may be pressure on the spinal nerves. This can lead to pain, numbness, or weakness.

Diagnostic Test for Herniated Disk

• EMG may be done to determine the exact nerve root that is involved.
• Myelogram may be done to determine the size and location of disk herniation.
• Nerve conduction velocity test may also be done.
• Spine MRI or spine CT will show that the herniated disk is pressing on the spinal canal.
• Spine x-ray may be done to rule out other causes of back or neck pain. However, it is not possible to diagnose a herniated disk by a spine x-ray alone.

Treatment

Mayo Clinic describes a conservative treatment that relieves the symptoms 90% of the time as avoidance of painful position. With this approach, people with herniated disk get better in one to two months. This is because the displaced portion of the disk shrinks over time.

Medications

• Over-the-counter medication can help alleviate mild to moderate pain. The doctor will identify for you the suitable over-the- counter medication. Just don’t forget that many of these drugs carry a risk of gastrointestinal bleeding, and large doses of acetaminophen may damage the liver.

• Narcotics may be prescribed by the doctor if the pain does not improve with over-the-counter medication. Follow closely your doctor’s advice and instruction on these medications.

• Nerve pain medications: Drugs such as gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta), tramadol (Ultram, Ryzolt) 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 such as diazepam (Valium) or cyclobenzaprine (Flexeril, Amrix) also may be prescribed if you have back or limb 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, using spinal imaging to more safely guide the needle.

Therapy

Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk. As the pain improves, physical therapy can advance you to a rehabilitation program of core strength and stability to maximize your back health and help protect against future injury. A physical therapist may also recommend:

• Heat or ice
• Traction
• Ultrasound
• Electrical stimulation
• Short-term bracing for the neck or lower back

If you have suffered or experienced pain from the negligence of another, please contact us at Christensen & Hymas.  Consultations are confidential and free.

Image “Cervical MRI Profile (C6/7 Herniation)” copyright by Nathan Yergler.

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