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The spinal bones (vertebrae) are separated by discs, which cushion the spine and allow movement between the vertebrae. A herniated disc (herniated disk), often called a slipped or ruptured disc, occurs when a part of the vertebrae pushes into the adjoining disc, putting pressure on the nearby nerves and causing pain or other symptoms.
Discs may move out of place (herniate) or break open (rupture) as a result of an injury or strain. This causes pressure that can lead to pain, numbness, or weakness. However, some people may experience no symptoms from a herniated disc.
The lower back (lumbar area) of the spine is the most common site of a herniated disc, although neck (cervical) discs can sometimes become herniated. Upper-to-mid back (thoracic) discs are rarely affected.
At UPMC, we begin with conservative treatments such as medications and physical therapy to alleviate pain and increase mobility. Most patients experience relief from pain within a month or two with conservative treatment. When these treatments fail to provide relief, our neurosurgical team may recommend surgery such as laminectomy, spinal fusion, or microdiscectomy.
In order to diagnose a herniated or slipped disc, the doctor will perform a physical exam and review your medical history. The doctor will check for numbness or loss of feeling in the extremities and check the patient’s reflexes, muscle strength, and posture.
Symptoms of a herniated disc vary depending on the location, such as the lumbar, cervical, or thoracic spinal area, of the affected disc. The most common symptoms may include:
A physical exam will be performed, and imaging tests such as x-ray, CT scan, MRI, discography, and myelogram may be ordered. Myelogram is a type of x-ray that uses dye injected into the space around the spinal cord to more clearly outline the space containing the spinal cord and nerves, which helps the doctor view any disc herniation. Electromyograms and nerve conduction studies may also be ordered to help identify the location of the nerve damage.
At UPMC, we begin with conservative treatment, such as pain medication, physical therapy, or a combination of both. Drug therapy may include non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, nerve pain medications, muscle relaxers, or epidural cortisone injections.
A physical therapist can recommend muscle strengthening exercises and stretches to minimize the pain of a herniated disc.
Patients whose symptoms are not improved by conservative therapy may benefit from surgery. Additionally, patients who experience progressive muscle weakness from a compressed nerve can get relief from surgery.
A laminectomy removes some of the bone over the spine and the problem disc. Spinal fusion is a technique in which two vertebrae (back bones) are fused together with bone grafts or metal rods. By fusing the vertebrae, the painful motion is eliminated. A microdiscectomy may also be done to remove the fragments of a herniated disc through a small incision.
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