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Herniated nucleus pulposus (slipped disk)

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk

Treatment:

The main treatment for a herniated disk is a short period of rest with pain and anti-inflammatory medications, followed by physical therapy. Over 95% of people will follow these treatments will recover and return to their normal activities. A small percentage of people need to have further treatment, which may include steroid injections or surgery.

MEDICATIONS

Non-steroidal anti-inflammatory medications (NSAIDs) and narcotic pain killers will be given to people with a sudden herniated disk caused by some sort of trauma (like a car accident or lifting a very heavy object) that is immediately followed by severe pain in the back and leg.

If the patient has back spasms, muscle relaxants are usually given. On rare occasions, steroids may be given either by pill or directly into the blood with an intravenous line (IV).

NSAIDs are used for long-term pain control, but narcotics may be given if the pain does not respond to anti-inflammatory drugs.

LIFESTYLE CHANGES

Any extra weight being carried by an individual, especially up front in the stomach area, will make back pain worse. Diet and exercise are crucial to improving back pain in overweight patients.

Physical therapy is important for nearly everyone with disk disease. Therapists will tell 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 taught in many therapy programs.

Some health care providers 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.

INJECTIONS

Steroid injections into the back in the area of the herniated disk can help control pain for several months. Such injections reduce swelling around the disk and relieve many symptoms. Spinal injections are usually done on an outpatient basis using x-ray or fluoroscopy to identify the area where the injection is needed.

SURGERY

Surgery may be an option for the few patients whose symptoms persist despite other treatments.

Diskectomy removes a protruding disk. This procedure requires general anesthesia (asleep and no pain) and 2-3 day hospital stay. 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 opening.

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.

Expectations (prognosis):

Most people will improve with conservative treatment. A small percentage may continue to have chronic back pain even after treatment.

It may take several months to a year or more to resume all activities without pain or strain to the back. People with certain occupations that involve heavy lifting or back strain may need to change job activities to avoid recurrent back injury.

Complications:

• Long-term back pain
• Permanent spinal cord injury (very rare)
  • Loss of movement or sensation in the legs or feet
  • Loss of bowel and bladder function

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.

• Review Date: 5/31/2006
• Reviewed By: Kevin B. Freedman, MD, MSCE, Sports Medicine, Orthopaedic Specialists, Bryn Mawr, PA. Review provided by VeriMed Healthcare Network.

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