Definition and Overview
A herniated disk, also known as a slipped disk, is a medical condition that involves a tear in the outer ring of the spinal disk. In some cases, the outer ring might not tear, but suffer from a similar damage that causes the same symptoms. The spinal disks function like support cushions in between the vertebrae, which, when stacked together, make up the spinal structure.
Though commonly referred to as a slipped disk, the term is not accurate, as the disks do not actually slip.
Spinal disks have a thick and tough exterior that protects a soft, jelly-like centre. When the outer casing of the disk is damaged, the soft centre pokes out, and this is what is known as a herniated disk. This condition can be extremely painful because it affects nearby nerves.
The condition is very common in older people as spinal disks degenerate over time, which makes the outer rings more susceptible to damage. Trauma, strain, or injuries are some of the most common causes. It can also result from the progression of a disk protrusion, a condition that involves the soft centre to push out, though the outer ring remains intact.
With proper care and treatment, minor cases can heal within a couple of weeks. However, more serious cases typically require more aggressive forms of treatment, such as surgery and physical therapy, before the patient can experience relief from the symptoms.
Cause of Condition
- Age-related degeneration of the fibrous outer ring in between the vertebrae - Over time, the tissues in the tough exterior grow weaker, with the soft centre becoming stiff. These changes in the structural integrity of the spinal disk lead to fissures and ruptures, causing herniation.
- General wear and tear
- Physically demanding jobs that require plenty of driving, squatting, lifting, or sitting
- Engaging in professional contact sports
- Simple activities or movements like bending to pick or lift something up, which could place undue pressure on the spine
- Traumatic events, such as slipping, falling, or a blow to the spine
In minor cases of herniated disks, the symptoms might be negligible. There are instances when patients are not aware that they have it, only to discover the condition when they undergo imaging procedures. This is because the affected disk does not irritate or touch the nerves surrounding it. However, spinal disk herniation that affects the neck (cervical spine) or the lower back (lumbar spine) can be extremely painful.
Pain in the arms or legs is one of the most common symptoms of herniated disk. Meanwhile, herniation in the lumbar spine can cause intense pain in the buttocks, calf, and thighs, as well as some parts of the foot. When the pain occurs in the shoulders and arms, the herniated disk is typically located in the cervical spine area. The pain becomes more noticeable or intense when the patient moves in a certain way that compromises the spine, or when the patient coughs or sneezes.
Certain body parts can also experience numbness due to this condition. This is caused by the nerves surrounding the herniated disk. Some patients also report tingling in certain body parts, which, as mentioned a while ago, is caused by the bulging centre of the spinal disks that irritates the surrounding nerves.
In more serious cases, patients can experience weakness in the extremities. They can stumble while walking or standing or feel weakness while holding or gripping objects. The reflexes and muscular strength can also be affected.
If the affected disk is located in the lumbar spine, the patient can suffer from sciatica because the bulging soft tissue affects the sciatic nerve. Sciatica involves shooting pain that starts from the back all the way to the legs and feet.
Typically, pain caused by herniated disk is continuously felt by the patient, and very much unlike the intermittent pain as felt with muscle spasms. The pain, which is often isolated in one part of the body, might also be continuous if the patient is in a certain body position that aggravates the nerves surrounding the herniated disk.
In cases of larger herniation, the patient can experience pain in both sides of the body. This is a more serious form of spinal disk herniation and should be treated right away to prevent further progression of the symptoms. Serious disk herniation can cause nerve damage, and a loss of control in bowel and bladder functions. Sexual dysfunction can also be an unpleasant symptom of this condition.
Who to See and Types of Treatment Available
When the patient experiences the symptoms describe above, it is best to consult with the family or regular physician first to determine if a herniated disk is indeed the cause of the symptoms. The doctor can then refer the patient to a specialist in physical medicine or rehabilitation, or in case surgical treatment or intervention is required, the patient can be referred to an orthopaedic surgeon or a neurosurgeon.
In many cases of spinal disk herniation, the patient will not require surgery to treat the condition. Many specialists will prescribe medication as initial treatment. Minor to moderate pain can be resolved by over-the-counter pain medication, such as naproxen or ibuprofen.
If the pain is not reduced by over-the-counter pain medication, the doctor can then prescribe narcotics to address the pain. Nerve pain medications are also an alternative for patients who, for any reason, cannot take narcotics. Other medication includes cortisone injections and muscle relaxants.
Physical therapy is also a great option for patients who do not want to take any medication and want long-term treatment results. Surgery is the last recourse for more serious cases of herniated disks.
Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078-93. http://www.ncbi.nlm.nih.gov/pubmed/19363456
Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniation. Orthop Clin North Am. 2010;41:217-224.http://www.ncbi.nlm.nih.gov/pubmed/20399360