An intervertebral disk is a saclike cushion of cartilage. One is found between each of the 33 vertebrae. Within each intervertebral disk is the nucleus pulposus, a soft, gelatinous mass that helps each disk cushion the movements of the vertebrae. A herniated intervertebral disk occurs when the nucleus pulposus protrudes through the wall of the disk and into the spinal canal, where it presses on spinal nerves and causes pain and disability. The condition is commonly called a slipped or ruptured disk. The most common sites for herniated disks are between the fourth and fifth lumbar vertebrae or between the fifth lumbar and the first sacral vertebrae. The condition is more common in men.
A herniated disk may be related to intervertebral joint degeneration. In this case, a minor trauma may result in a disk herniation. A herniated intervertebral disk likely is caused by spinal trauma from a fall, straining, or heavy lifting. The herniation may occur at the time of the trauma or sometime later.
FIGURE. Herniated spinal disk
Signs and Symptoms
Symptoms depend on the particular site of herniation, but severe back pain that worsens with motion is common. Sensation of numbness, prickling, or tingling known as paresthesia, and restricted mobility of the neck often occurs. Coughing, sneezing, or bending intensifies the pain and discomfort. The sciatic nerve may be painful on the application of pressure. The sciatic pain may begin as a dull ache and progress to severe pain. The term sciatica is often used when considering symptoms of a herniated disk. A bad leg cramp that lasts for weeks before it goes away is often referred to as sciatica because the herniated (or even swollen) disk presses directly on nerve roots that become the sciatic nerve.
Obtaining a thorough client history is important to rule out other causes of back pain. The diagnosis is confirmed if the individual complains of sciatic pain when a straight-leg-raising test is performed. In addition, spinal x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) may be ordered to confirm the diagnosis and to determine the level of herniation. Myelography may show the point of spinal compression caused by the herniated disk.
Bed rest, alternating heat and cold applied to the affected portion of the spine, and salicylate analgesics may be prescribed. Muscle relaxants may be helpful. Traction of the lower extremities and a back brace may be beneficial in the event of a herniated lumbosacral disk. If conservative treatment is not successful, surgical removal of the herniated disk may be necessary (laminectomy). Endoscopic microdiskectomy is an alternative to the open removal of the disk if only small fragments of the vertebra need to be removed. With endoscopic microdiskectomy, a small incision is made and a camera is inserted to locate the fragments of bone. Special instruments are used to remove the fragments with minimal damage to surrounding tissue. Spinal fusion may be necessary to stabilize the spine.
Prolotherapy has shown some success. This type of therapy involves the injection of natural substances into the ligaments to stimulate growth of collagen to strengthen damaged joints, tendons, ligaments, or muscles. It is a nonsurgical treatment modality. Acupuncture and massage can provide short-term relief of lower back pain.
Remind clients not to expect an “instant fix” for a herniated disk. Bed rest is essential but not easily achieved and often frustrates clients. Clients may be referred to a physical therapist who can assist in proper movement, body mechanics, and exercise. Prepare the client for surgery if necessary.
About 1 in every 50 persons will experience a herniated disk. Often the symptoms last longer than 5 weeks. About 80% to 90% of people get better over time. However, where there is still disabling pain after 3 months or more of treatment, surgery is considered.
The use of proper lifting techniques may help pre vent herniated intervertebral disks.