A herniated disc is sometimes also known as a slipped disc or prolapsed disc. It can occur anywhere in the spine although is most common in the lower back.
A slipped disc can manifest itself with a number of symptoms including back pain, leg pain, neural symptoms as well as bowel and bladder problems. Treatment can be conservative which may involve rest and exercises or surgical.
What is a Herniated Disc?
The intervertebral discs are roughly round pads of cartilage which sit between each spinal vertebra (bone). Their job is to provide shock absorbtion and to allow the movements of flexion, extension, side bending and rotation at the lower back.
Whilst lumbar disc herniations can occur at any point in the spine, they are most common in the lumbar (lower back) region. Here there are 5 lumbar vertebrae, separated by 5 intervertebral discs. Each vertebrae has a body (large circular area at the front) and three bony processes which protrude out the back. These are the two transverse processes and the central spinous process. Between the body and these processes is a circular hole, which together with the vertebrae above and below, forms a column through which the spinal cord passes.
The intervertebral disc are made up of three parts. The vertebral end plates, the annulus fibrosus and in the centre, the nucleus pulposus. It is this central part which may herniate, through a weakened, degenerated wall (annulus fibrosus).
If the disk herniates far enough it can put pressure on the spinal column where it passes behind the discs and vertebral bodies. It is this pressure on the spinal cord which refers pain and other symptoms into the legs.
What are the Symptoms?
90% of lumbar spine herniations occur at either L4/L5 or L5/S1. Where the herniation and so spinal cord compression occurs, dictates the symptoms the individual will feel. In most cases some degree of lower back pain will be felt and this may be accompanied by:
In the L5/S1 disc herniation the pain is often felt down the back of the leg, often as far as the foot (see sciatica).
With L4/L5 herniations the pain may be felt more on the outside of the leg and down into the shin or top of the foot.
L3/L4 herniations often produce pain on the outer hip and round onto the front of the thigh.
Neural symptoms are those produced b a nerve and include tingling, numbness and weakness. These symptoms are common in those with a slipped disc and tend to be in the areas described above, in line with areas of pain.
Weakness in the foot is especially common, with difficulty lifting the foot (known as foot drop) often reported in those with L4/L5 herniation.
Pain often occurs after a relatively simple movement, such as bending over to pick up something light off the floor. It is often aggravated by sitting, bending, lifting and coughing or sneezing. It is often eased by lying down, especially on the unaffected side and may be at its best first thing in the morning.
Bladder / Bowel Symptoms
If there are any symptoms of a loss of bladder or bowel control then this should be treated as a medical emergency. It could be a condition known as Cauda Equina syndrome which is a serious condition as it may result in permanent loss of bladder or bowel control and paralysis in the lower body. Seek medical attention immediately.
How is a Slipped Disc Diagnosed?
If you think you may have a slipped disc the best course of action is to visit your Doctor. He/she will be able to make an assessment and determine if what treatment or investigations are needed.
Treatment of Lumbar Disc Herniation
In many cases a slipped disc in the lower back will heal with conservative treatment. Initially this should involve rest and the use of anti-inflammatory medications or NSAID's such as Ibuprofen.
Physical therapy may help, with the use of gentle mobilisations and extension exercises. A corticosteroid injection may be given in severe cases which show no signs of improvement naturally.
Traction is often helpful for patients with a disc herniation, although in some cases the intial pain relief was followed by an increase in pain after treatment.
in cases where the symptoms do not improve or the individual suffers repeated bouts of pain, surgery may be an option.
There are two procedures which may be carried out:
A microdiscectomy involves removing only the portion of the disc which has herniated, leaving the rest of the disc intact. In most cases this is successful although patients may be prone to further episodes. The surgery is usually performed on an out-patient basis and the individual can be back to full work duties within 1-3 weeks.
For substantial or repeated herniations a full discectomy may be performed. In this case the entire disc is removed and the vertebrae above and below are fused.
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