A spinal disc herniation, incorrectly called a "slipped disc", is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... See drugs, medication, and pharmacology for substances that are used to treat patients. ... Look up spine on Wiktionary, the free dictionary. ... Each intervertebral fibrocartilage is composed, at its circumference, of laminæ of fibrous tissue and fibrocartilage, forming the annulus fibrosus. ... Intervertebral discs lie in between adjacent vertebrae in the spine. ... Nucleus pulposus is the jelly-like substance in the middle of the spinal disc. ... A hernia is often likened to the failure of a tire. ...

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure.

Terminology

Normal situation and spinal disc herniation in cervical vertebrae.

Some of the terms commonly used to describe the condition include herniated disc, prolapsed disc, ruptured disc, and the misleading expression "slipped disc." Other terms that are closely related include disc protrusion, bulging disc, pinched nerve, sciatica, disc disease, disc degeneration, degenerative disc disease, and black disc.^[1]. Image File history File links Size of this preview: 800 × 343 pixel Image in higher resolution (3256 × 1394 pixel, file size: 407 KB, MIME type: image/png) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): User talk:JoJan... Image File history File links Size of this preview: 800 × 343 pixel Image in higher resolution (3256 × 1394 pixel, file size: 407 KB, MIME type: image/png) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): User talk:JoJan... A diagram of a thoracic vertebra. ... Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ...

The popular term "slipped disc" is quite misleading, as an intervertebral disc, being tightly sandwiched between two vertebrae to which the disc is attached, cannot actually "slip," "slide," or even get "out of place." The disc is actually grown together with the adjacent vertebrae and can be squeezed, stretched, and twisted, all in small degrees. It can also be torn, ripped, herniated, and degenerated, but it cannot "slip."^[2][3][4] However, one vertebral body can slip relative to an adjacent vertebral body. This is called spondylolisthesis and damages the disc between the two vertebrae. A diagram of a thoracic vertebra. ... Spondylolisthesis (not to be confused with spondylosis or spondylolysis), also known as hangmans fracture, is an anteroposterior translatory movement (displacement) of two spinal vertebrae in relationship to each other caused by instability between the two involved vertebrae. ...

The spelling "disc" is based on the Latin root discus. Most English language publications use the spelling "disc" more often than "disk." Nomina Anatomica designates the structures as "disci intervertebrales" [plural form] and Terminologia Anatomica as "discus intervertebralis/Intervertebral disc," [singular form].^[5] Latin is an ancient Indo-European language originally spoken in Latium, the region immediately surrounding Rome. ... The Nomina Anatomica was one of the most popular systems for providing topographical codes in the 20th century. ... The Nomina Anatomica was one of the most popular systems for providing topographical codes in the 20th century. ... Intervertebral discs lie in between adjacent vertebrae in the spine. ...

Regional distribution

Frequency

Stages of Spinal Disc Herniation

Disc herniation can occur in any disc in the spine, but the two most common forms are the cervical disc herniation and the lumbar disc herniation. The latter is the most common, causing lower back pain (lumbago) and often leg pain as well, in which case it is commonly referred to as sciatica. Image File history File links Disc_Herniation. ... Image File history File links Disc_Herniation. ... Lumbago is a term used to refer to low back pain. ... Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ...

Lumbar disc herniation occurs 15 times more often than cervical (neck) disc herniation, and it is one of the most common causes of lower back pain. The cervical discs are affected 8% of the time and the upper-to-mid-back (thoracic) discs only 1 - 2% of the time.^[6]

The following locations have no discs and are therefore exempt from the risk of disc herniation: the upper two cervical intervertebral spaces, the sacrum, and the coccyx. For the record label, see Sacrum Torch The sacrum is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. ... The coccyx is formed of four fused vertebrae. ...

Most disc herniations occur when a person is in their thirties or forties when the nucleus pulposus is still a gelatin-like substance. With age the nucleus pulposus changes ("dries out") and the risk of herniation is greatly reduced. After age 50 or 60, osteoarthritic degeneration or spinal stenosis are more likely causes of low back pain or leg pain. Osteoarthritis (OA, also known as degenerative arthritis or degenerative joint disease, and sometimes referred to as arthrosis or osteoarthrosis or in more colloquial terms wear and tear), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and... This article or section does not adequately cite its references or sources. ... It has been suggested that this article or section be merged with Back pain. ...

Cervical disc herniation

Cervical disc herniations occur in the neck, most often between the sixth and seventh cervical vertebral bodies. Symptoms can affect the back of the skull, the neck, shoulder girdle, scapula, shoulder, arm, and hand. The nerves of the cervical plexus and brachial plexus can be affected.^[7] The cervical plexus is a plexus of the ventral roots of the first four cervical spinal nerves which are located from C1 to C4 cervical segment near the neck. ... The brachial plexus is an arrangement of nerve fibres (a plexus) running from the spine (vertebrae C5-T1), through the neck, the axilla (armpit region), and into the arm. ...

Thoracic disc herniation

Thoracic discs are very stable and herniations in this region are quite rare. Herniation of the uppermost thoracic discs can mimic cervical disc herniations, while herniation of the other discs can mimic lumbar herniations.^[8]

Lumbar disc herniation

Lumbar disc herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttocks, thigh, and may radiate into the foot and/or toe. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica. The femoral nerve can also be affected.^[9] Can cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet. In anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis). ... For the record label, see Sacrum Torch The sacrum is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. ... Bottom commonly refers to the human buttocks but also has other uses The buttocks (anatomical nates, clunium, gluteus, regio glutealis) are rounded portions of the anatomy located on the posterior of the pelvic region of the apes, humans and many other bipeds or quadrupeds. ... Diagram of the human thigh bone In humans the thigh is the area between the pelvis and buttocks and the knee. ... For other uses, see Foot (disambiguation). ... Toes on foot. ... This article or section may be confusing or unclear for some readers, and should be edited to rectify this. ... Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ... The Femoral Nerve supplies innervation the anterior portion of the leg. ...

Causes

Causes of a disc herniation can include general wear and tear on the disc over time, repetitive movements, stress on the disc that occurs while twisting and lifting, or other injuries.

Symptoms

The chief complaint for spinal disc herniation is leg pain greater than lower back pain, symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured to severe and unrelenting neck or low back pain that will radiate into the regions served by an affected nerve root when it is irritated or impinged by the herniated material. Other symptoms may include sensory changes such as numbness, tingling, muscular weakness, paralysis, paresthesia, and affection of reflexes. If the herniated disk is of the Lumbar region the patient may also experince sciatica due to irritation of the sciatic nerve. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous. The chief complaint (CC) is a concise statement describing the symptom, problem, condition, diagnosis, physician recommended return, or other factor that is the reason for a medical encounter[1]. See also Medical history Category: ... Low back pain can be either an acute or chronic disabling condition. ... It has been suggested that this article or section be merged with Back pain. ... Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep. // Transient paresthesia is the temporary sensation of tingling... Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ... This article or section may be confusing or unclear for some readers, and should be edited to rectify this. ...

It is possible to have a herniated disc without any pain or noticeable symptoms, depending on its location. If the extruded nucleus pulposus material doesn't press on soft tissues or nerves, it may not cause any symptoms. It has been estimated that as many as 50% of the population have focal herniated discs in their cervical region that do not cause noticeable symptoms.^[10]

Typically, symptoms are experienced only on one side of the body. If the prolapse is very large and presses on the spinal cord or the cauda equina in the lumbar region, affection of both sides of the body may occur, often with serious consequences. The cauda equina is a structure within the lower end of the spinal column, that consists of nerve roots and rootlets from above. ...

Diagnosis

Diagnosis is made by a practitioner based on the history, symptoms, and physical examination. At some point in the evaluation, tests may be performed to confirm or rule out other causes of symptoms such as spondylolisthesis, degeneration, tumors, metastases and space-occupying lesions as well as evaluate the efficacy of potential treatment options. These tests may include the following: In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Spondylolisthesis (not to be confused with spondylosis or spondylolysis), also known as hangmans fracture, is an anteroposterior translatory movement (displacement) of two spinal vertebrae in relationship to each other caused by instability between the two involved vertebrae. ... Tumor or tumour literally means swelling, and is sometimes still used with that meaning. ... Metastasis (Greek: change of the state) is the spread of cancer from its primary site to other places in the body. ...

• X-ray: Although traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, they are still used to confirm or exclude other possibilities such as tumors, infections, fractures, etc.. In spite of these limitations, X-ray can still play a relatively inexpensive role in confirming the suspicion of the presence of a herniated disc. If a suspicion is thus strengthened, other methods may be used to provide final confirmation.
• Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays. It can show the shape and size of the spinal canal, its contents, and the structures around it, including soft tissues.

MRI Scan of lumbar disc herniation between fourth and fifth lumbar vertebral bodies.

• Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors. It shows soft tissues even better than CAT scans.
• Myelogram: An x-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces. By revealing displacement of the contrast material, it can show the presence of structures that can cause pressure on the spinal cord or nerves, such as herniated discs, tumors, or bone spurs. Because it involves the injection of foreign substances, scans are now preferred when available, although myelograms still provide excellent outlines of space-occupying lesions.
• Electromyogram and Nerve conduction studies (EMG/NCS): These tests measure the electrical impulse along nerve roots, peripheral nerves, and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury, or whether there is another site of nerve compression.

In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... This article does not adequately cite its references or sources. ... Image File history File linksMetadata LumbarDiscHerniation. ... Image File history File linksMetadata LumbarDiscHerniation. ... Magnetic Resonance Image showing a median sagittal cross section through a human head. ... Myelography is a type of radiographic examination which uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors. ... Bone spur - Wikipedia /**/ @import /skins/monobook/IE50Fixes. ... Electromyography (EMG) is a medical technique for evaluating and recording physiologic properties of muscles at rest and while contracting. ... A nerve conduction study (NCS) is a test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. ...

Treatment

The majority of herniated discs will heal themselves in about six weeks and do not require surgery. ^[11] Pain medications are often prescribed to alleviate the acute pain and allow the patient to begin exercising and stretching.

The presence of cauda equina syndrome (in which there is incontinence, weakness and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression. Cauda equina syndrome is a serious neurologic condition in which there is compression of the vertebral column (spine) affecting the S1-S4 nerve roots. ...

There are a variety of non-surgical care alternatives to treat the pain, including:

1. Physical therapy
2. Osteopathic/chiropractic manipulations
3. Massage therapy
4. Non-steroidal anti-inflammatory drugs (NSAIDs)
5. Oral steroids (e.g. prednisone or methyprednisolone)
6. Epidural (cortisone) injection
7. Intravenous sedation, analgesia-assisted traction therapy (IVSAAT)

If pain is severe and continuous, or if there are neurological deficits, surgery may be recommended. Surgical options include: Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ... Chiropractic is a complementary and alternative health care profession with the purpose of diagnosing and treating mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health. ... In alternative medicine, body work or massage therapy refers to any treatment which involves some form of touching or physical manipulation. ... Wikipedia does not yet have an article with this exact name. ... This article or section does not adequately cite its references or sources. ... The term epidural is often short for epidural anesthesia, a form of regional anesthesia involving injection of drugs through a catheter placed into the epidural space. ... Cortisone (IPA:ˈkôrtəˌsōn) is a steroid hormone. ...

1. Microdiscectomy^[12]
2. Lumbar fusion (lumbar fusion is only indicated for recurrent lumbar disc herniations, not primary herniations)
3. Anterior cervical discectomy and fusion (for cervical disc herniation)
4. Disc arthroplasty (experimental for cases of cervical disc herniation)
5. Dynamic stabilization (dynamic stabilization is an experimental procedure with no data supporting its use for primary disc herniations)
6. Artificial disc replacement

Surgical goals include relief of nerve compression, allowing the nerve to recover, as well as the relief of associated back pain and restoration of normal function. Artificial disc replacement is a medical procedure in which degenerated discs in the spine are replaced with artificial ones. ...

Classical surgery for lumbar disc herniation is carried out by using a vertical median incision over the level which has an herniation. The dorsolumbar fascia is incised about 0.5 cm laterally on the affected side. The paravertebral muscles are dissected free from underlying bony structures, namely the spinous process and laminae, and retracted laterally. The level of disc herniation is identified using C-arm fluoroscopy or palpating the sacrum. The lamina is then fenestrated with bone rongeurs after which the exposed ligamentum flavum (the yellow ligament) is excised. The epidural soft tissue and venous plexus is gently explored to find the nerve root exiting from the associated neural foramina. The herniated disc is usually found beneath the nerve root. The nerve root is protected using root retractors. The posterior longitudinal ligament is incised with a fine blade and herniated disc material and degenerated nucleus pulposus are evacuated using different kinds of disc forcepses. Meticulous control of haemostasis is employed and irrigation with warm saline is essential. The muscle layers and the fascia is repaired, generally, without using a drain. The skin wound is closed.

Anterior cervical discectomy and fusion

Cervical intervertebral disc herniations are operated using a horizontal paramedian anterior neck incision parallel to skin folds, a surgical procedure called Anterior cervical discectomy and fusion. After dissecting the neck structures (which are vital organs, such as trachea, esophagus, carotid arteries etc.), the front of the vertebral column is reached and exposure is maintained by automatic retractors. The dissection is blunt and is carried out through natural anatomic planes, thus causing minimal trauma to tissues here. The level is again verified using the C-arm. The disc is evacuated using curettes and high speed drills. The surgeon may place an intervertebral support, such as autologous bone or allogrefts, or metallic elements for fusion. The incision is then closed layer by layer. Another approach for cervical herniations is the posterior approach, which is basically identical to surgical treatment for lumbar disc surgery. The decision of which route to employ is arrived after complete workup of a patient. Image File history File links Size of this preview: 722 × 599 pixel Image in higher resolution (1371 × 1138 pixel, file size: 147 KB, MIME type: image/png) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): User talk:JoJan... Image File history File links Size of this preview: 722 × 599 pixel Image in higher resolution (1371 × 1138 pixel, file size: 147 KB, MIME type: image/png) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): User talk:JoJan... Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure to treat nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine in order to stabilize the corresponding vertebrae. ... Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure to treat nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine in order to stabilize the corresponding vertebrae. ...

Future treatments may include stem cell therapy. Doctors Victor Y. L. Leung, Danny Chan and Kenneth M. C. Cheung have reported in the European Spine Journal that "substantial progress has been made in the field of stem cell regeneration of the intervertebral disc. Autogenic mesenchymal stem cells in animal models can arrest intervertebral disc degeneration or even partially regenerate it and the effect is suggested to be dependent on the severity of the degeneration."^[13] Mesenchymal stem cells or MSCs are multipotent stem cells that can differentiate into a variety of cell types. ...

See also

• Back pain
• Degenerative disc disease
• Low back pain
• Sciatica
• Vertebral column

It has been suggested that this article or section be merged with Low back pain. ... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ... It has been suggested that this article or section be merged with Back pain. ... Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ... The vertebral column seen from the side Different regions (curvatures) of the vertebral column The vertebral column (backbone or spine) is a column of vertebrae situated in the dorsal aspect of the abdomen. ...

References

External links

• Herniated disc - Cedars-Sinai Health System
• Herniated Nucleus Pulposus - eMedicine.com
• What's a herniated disc, pinched nerve, bulging disc...? - Spine-health.com
• Lumbar herniated disc animation - Spine-health.com
• Herniated lumbar disc - North American Spine Society
• Back pain and neck pain for patients - Spine-health.com