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Herniated nucleus pulposus (slipped disk)
Alternative namesLumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk
DefinitionA condition in which part or all of the soft, gelatinous central portion of an intervertebral disk (the nucleus pulposus) is forced through a weakened part of the disk, resulting in back pain and leg pain caused by nerve root irritation.
Causes, incidence, and risk factors
The bones of the spinal column, or vertebrae, run down the back connecting the skull to the pelvis. These bones protect nerves as they exit the brain and travel down the back and then to the entire body.
The spinal column is divided into several segments -- the cervical spine (the neck), the thoracic spine (the part of the back behind the chest), the lumbar spine (lower back), and sacral spine (the part connected to the pelvis that does not move).
The spinal vertebrae are separated by cartilage disks filled with a gelatinous substance, that provide cushioning to the spinal column. These disks may herniate (move out of place) or rupture from trauma or strain , especially if degenerative changes have occurred in the disk.
SYMPTOMS OF HERNIATED LUMBAR DISK
SYMPTOMS OF HERNIATED CERVICAL DISK
Signs and tests
A physical examination and history of pain may be sufficient to diagnose the disorder. A neurological examination will be performed to evaluate muscle reflexes, sensation, and muscle strength. Often, examination of the spine will reveal a decrease in the spinal curvature in the affected area.
The mainstay of treatment for herniated disks is an initial period of rest with pain and anti-inflammatory medications, followed by physical therapy. Under this regimen, over 95% of people will recover and return to their normal activities. A small percentage of people do need to go on and have further treatment which may include steroid injections or surgery.
If there is also an element of back spasm, anti-spasm drugs, also called muscle relaxants, are usually given. On rare occasions, steroids may be administered either by pill or directly into the blood with an intervenous line (IV).
Long-term pain control is usually limited to NSAIDs, but occasionally narcotics are used as well (if the pain does not respond to NSAIDs).
For people unable to do physical therapy because of pain, steroid injections into the back in the area of the herniation can be very helpful in controlling pain for several months. This allows a vigorous therapy program to be initiated which will usually control pain for the long-term.
Physical therapy is another crucial treatment for nearly everyone with lumbar disk disease. Therapists will instruct you how to properly lift, dress, walk, and perform other activities.
They will also work on strengthening the muscles of the abdomen and lower back to help support the spine. Flexibility of the spine and legs is the third aspect of most therapy programs.
Some practitioners recommend the use of back braces to help support the spine. However, overuse of these devices can weaken the abdominal and back muscles leading to a worsening of the problem. Weight belts can be helpful in preventing injuries in those whose work requires lifting of heavy objects.
Diskectomy is performed to remove a protruding disk under general anesthesia. The hospital stay is short, about 2-3 days. You will be encouraged to walk the first day after surgery to reduce the risk of blood clots .
Complete recovery takes several weeks. If more than one disk needs to be taken out or if there are other problems in the back besides a herniated disk, more extensive surgery may be needed. This may require a much longer recovery period.
Other surgical options include micro diskectomy, a procedure removing fragments of nucleated disk through a very small incision with X-ray guidance and chemo nucleosis.
Chemonucleolysis involves the injection of an enzyme (called chymopapain) into the herniated disk to dissolve the protruding gelatinous substance. This procedure may be an alternative to diskectomy in certain situations.
Most people will improve with conservative treatment. A small percentage may continue to have chronic back pain even after treatment. People who injure themselves on the job tend not to do as well as those without such injuries.
It may take several months to a year or more to resume all activities without pain or strain to the back. Certain occupations that involve heavy lifting or back strain may need modification to avoid recurrent back injury.
Calling your health care provider
Call your health care provider if persistent, severe back pain develops, especially if there is any numbness or loss of movement .
Safe work and play practices, proper lifting techniques, and weight control may help to prevent back injury in some people.
Update Date: 6/12/2002Kevin B. Freedman, M.D., Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Chicago, IL. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT