Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually, one side left or right is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Straightening the leg on the affected side can often make the pain worse.
Along with leg pain, one may experience low back pain; however, for acute sciatica the pain in the leg is often worse than the pain in the low back. Cervical spine neck : Cervical radiculopathy is the symptoms of nerve compression in the neck, which may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers or numbness or tingling in the shoulder or arm.
The pain may increase with certain positions or movements of the neck. Fortunately, the majority of herniated discs do not require surgery.
The time to improve varies, ranging from a few days to a few weeks. Testing modalities are listed below. The most common imaging for this condition is MRI. Plain x-rays of the affected region are often added to complete the evaluation of the vertebra.
Please note, a disc herniation cannot be seen on plain x-rays. CT scan and myelogram were more commonly used before MRI, but now are infrequently ordered as the initial diagnostic imaging, unless special circumstances exist that warrant their use. An electromyogram is infrequently used. The initial treatment for a herniated disc is usually conservative and nonsurgical.
A doctor may advise the patient to maintain a low, painless activity level for a few days to several weeks. This helps the spinal nerve inflammation to decrease.
Myelograms can show a nerve being pinched by a herniated disc, bony overgrowth, spinal cord tumors, and abscesses.
A CT scan may follow this test. Computed Tomography CT scan is a noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of your spine. This test is especially useful for confirming which disc is damaged. EMG tests measure the electrical activity of your muscles. Small needles are placed in your muscles, and the results are recorded on a special machine.
NCS is similar, but it measures how well your nerves pass an electrical signal from one end of the nerve to another. These tests can detect nerve damage and muscle weakness.
X-rays view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, or fractures. It's not possible to diagnose a herniated disc with this test alone. Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, physical therapy, home exercises, hydrotherapy, epidural steroid injections ESI , chiropractic manipulation, and pain management.
Self care : In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks. Medication : Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications NSAIDs , muscle relaxants, and steroids.
Steroid injections : The procedure is performed under x-ray fluoroscopy and involves an injection of corticosteroids and a numbing agent into the epidural space of the spine. The medicine is delivered next to the painful area to reduce the swelling and inflammation of the nerves Fig.
Repeat injections may be given to achieve the full effect. Duration of pain relief varies, lasting for weeks or years. Physical therapy: The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury. Exercise and strengthening exercises are key elements to your treatment and should become part of your life-long fitness. Surgery for a herniated lumbar disc, called a discectomy, may be an option if your symptoms do not significantly improve with conservative treatments.
Surgery may also be recommended if you have signs of nerve damage, such as weakness or loss of feeling in your legs. Microsurgical discectomy : The surgeon makes a 1—2 inch incision in the middle of your back. To reach the damaged disc, the spinal muscles are dissected and moved aside to expose the vertebra.
A portion of the bone is removed to expose the nerve root and disc. The portion of the ruptured disc that touches your spinal nerve is carefully removed using special instruments. Minimally invasive microendoscopic discectomy : The surgeon makes a tiny incision in the back.
Herniated disk The rubbery disks that lie between the vertebrae in your spine consist of a soft center nucleus surrounded by a tougher exterior annulus. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Herniated disc. American Association of Neurological Surgeons. Accessed Aug. Herniated disc. Mayo Foundation for Medical Education and Research; Levin K, et al. Acute lumbosacral radiculopathy: Treatment and prognosis.
Herniated disk. Applying cold packs to the painful area when you first start to feel pain can help to numb the nerves and reduce your discomfort. Heating pads and hot baths later can reduce tightness and spasms in the muscles of the lower back so you can move more freely. Learn more about treating pain with cold and heat.
Over-the-counter OTC pain relievers can help to reduce pain and inflammation. These may include:. Take the recommended dosage. Extended bed rest is not recommended for back pain, though taking it easy for a few hours at a time is fine. Otherwise, try to walk around a bit throughout the day and stick to normal daily activities as much as possible, even if it hurts a little.
When your pain starts to subside, gentle exercise and stretches can help you return to normal activities, including work. But make sure to get instructions from your doctor or see a physical therapist to show you safe exercises and stretches for back pain. Spinal manipulation chiropractic , massage, and acupuncture may help relieve pain and discomfort while your back is healing. Make sure the person who provides these services is a licensed professional. Tell them about your ruptured disc so that they can properly treat your condition.
Many people at this stage start thinking about surgery. Injections can provide relief for up to a few months, but the relief will wear off. There are limits on how many injections you can safely have in a given year. Deciding to move forward with surgery is an individual decision.
Your doctor should explain all the pros and cons so that you can make an informed decision that fits your lifestyle. The most common surgery is called diskectomy.
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