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by EBSCO Medical Review Board
(Herniation of Nucleus Pulposus [HNP]; Prolapsed Disc; Ruptured Disc; Slipped Disc)

Definition

A herniated disc is a bulging of one of the small, round discs between the bones of the spine. A disc that bulges from its proper place puts pressure on spinal nerves. It can cause pain and weakness in limbs. Problems are more common in the lower spine.

Herniated Lumbar Disc
Nucleus factsheet image
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Causes

Common causes are:

  • The natural aging process (most common cause)
  • Genetics
  • Poor posture and body mechanics
  • Too much pressure on the spine, such as from an inactive lifestyle
  • Recent trauma, such as a fall or motor vehicle accident

Risk Factors

This problem is more common in older adults. Other things that may raise the risk are:

  • Obesity
  • A history of low back pain
  • Long periods of standing and bending forward
  • Smoking
  • Strenuous activities, such as heavy lifting
  • Genetic problems related to discs

Symptoms

The main symptom is pain that may:

  • Be sharp, dull, piercing, aching, burning, or throbbing
  • May spread over the back, buttocks, down the back of one thigh, and into the calf or through shoulders and arms
  • Be in one leg or both legs or arms

Other problems may be:

  • Numbness, tingling, or weakness in the legs, feet, or in one or both arms
  • A sudden aching or twisted neck that cannot be straightened without feeling pain
  • Numbness in the groin (rare)
  • Bowel or bladder changes (rare)

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. It will focus on the spine. Images may be taken of the spine. This can be done with:

Treatment

Most people start to feel better in a few days or weeks. Staying active may be better than full rest. The goal of treatment is to manage symptoms. Choices are:

  • Supportive care, such as not sitting for long periods of time, avoiding things that cause pain, and using cold or warm compresses
  • Physical therapy to promote strength, flexibility, and range of motion
  • Medicines, such as:
    • Over-the-counter or prescription pain relievers
    • Steroid injections to ease pain and swelling

People who are not helped by these methods may need surgery. Choices are:

  • Laminectomy to remove some of the bone over the spine and problem disc
  • Microdiscectomy to remove fragments of herniated disc through a small incision
  • Spinal fusion to fuse vertebrae together with bone grafts or metal rods (rare)

Prevention

Exercise and improved strength may help some prevent herniated discs.

RESOURCES

North American Spine Society  http://www.spine.org 

Ortho Info—American Academy of Orthopaedic Surgeons  http://www.orthoinfo.org 

CANADIAN RESOURCES

Canadian Orthopaedic Association  http://www.coa-aco.org 

Canadian Orthopaedic Foundation  http://www.canorth.org 

References

Deyo RA, Mirza SK. CLINICAL PRACTICE. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016 May 5;374(18):1763-1772.

Herniated disk in the lower back. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back. Accessed February 17, 2021.

Lumbar disk herniation. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/lumbar-disk-herniation. Accessed February 17, 2021.

Revision Information