When people say they have a "slipped" or "ruptured" disk in their neck or lower back, what they are actually describing is a herniated disk - a common source of pain in the neck, lower back, arms, or legs.
Disks are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and associated nerve roots. The disks between the vertebrae allow the back to flex or bend. Disks also act as shock absorbers.
Disks in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the disks are similar but smaller in size.
A disk herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs.
Nonsurgical treatment is effective in treating the symptoms of herniated disks in more than 90% of patients. Most neck or back pain will resolve gradually with simple measures.
- Rest and over-the-counter pain relievers may be all that is needed.
- Muscle relaxers, analgesics, and anti-inflammatory medications are also helpful.
- Cold compresses or ice can also be applied several times a day for no more than 20 minutes at a time.
- After any spasms settle, gentle heat applications may be used.
Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return-as can taking short walks and avoiding sitting for long periods. For the lower back, exercises may also be helpful in strengthening the back and abdominal muscles. For the neck, exercises or traction may also be helpful. To help avoid future episodes of pain, it is essential that you learn how to properly stand, sit, and lift.
If these nonsurgical treatment measures fail, epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks.
Surgery may be required if a disk fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the lower back include microdiskectomy or laminectomy, depending on the size and position of the disk herniation.
In the neck, an anterior cervical diskectomy and fusion (ACDF) are usually recommended. This involves removing the entire disk to take the pressure off the spinal cord and nerve roots. Bone is placed in the disk space and a metal plate may be used to stabilize the spine.
Each of these surgical procedures is performed with the patient under general anesthesia. They may be performed on an outpatient basis or require an overnight hospital stay.