Herniated Disk

What is this Condition?

Herniated disk is a back problem that starts when all or part of the soft, central portion of a spinal disk is forced through the disk's weakened or torn outer ring. When this happens, the protruding disk may rub against spinal nerve roots or the spinal cord itself, causing back pain and other signs of pinched nerves. Herniated disks mostly affect men under age 45. What Causes it?

Herniated disks may result from a bad fall or strain, or may be related to joint degeneration. In elderly people, whose disks have begun to degenerate, a minor injury may cause herniation. Most disk damage (90%) occurs in the lower back; 8%, in the neck area; and 1% to 2%, at chest level.

A person with this condition who was born with a small lower back spinal canal or who has abnormal vertebral bone formation may be more susceptible to pinched and damaged nerves. What are its Symptoms?

The main symptom of lower-back herniated disk is severe, low back pain, which radiates to the buttocks, legs, and feet, usually on one side. If the disk was hurt in a fall, the pain may begin suddenly, fade in a few days, then recur and intensify. Hip pain follows, beginning as a dull pain in the buttocks. Coughing, sneezing, or bending intensifies the pain and sometimes causes muscle spasms.

Herniated disk may also cause numbness around the pinched spinal nerve and, in later stages, weakness of the leg muscles.

How is it Diagnosed?

The doctor will ask for detailed information about what causes pain because that helps pinpoint the damage. The person will be put through several leg-raising and other motion tests to check for evidence of a pinched nerve. A spinal X-ray won't show the damaged disk, but can rule out other causes of leg pain or numbness.

After the physical exam and X-rays, additional scans using a dye or multiple views can show a more exact picture of herniated disk material.

How is it Treated?

Treatment depends on the severity of the damage done by the herniated disk and can include the following:

• several weeks in bed, possibly in pelvic traction, unless nerve damage progresses rapidly. This conservative treatment progresses to an exercise program. The person may use a hot pad and take aspirin to reduce inflammation and swelling. Sometimes, the doctor prescribes muscle relaxants or, rarely, corticosteroids .

• surgery for a herniated disk that fails to respond to conservative treatment. The most common procedure, called laminectomy, involves removing a portion of a thin plate of bone and the protruding disk. If surgery doesn't relieve symptoms, a spinal fusion may be necessary to stabilize the spine.

• instead of laminectomy, injection of an enzyme called Chymodiactin into the herniated disk to dissolve the disk's nucleus, or microsurgery to remove fragments of the damaged disk.