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Slipped Disc
DISCS HAVE A SOFT, SPONGY INTERIOR contained inside a tough, fibrous outer layer. Intervertebral discs are part of specialized joints that connect the 33 bones (vertebrae) of your spinal column. These discs provide flexibility and shock absorption to your neck and back.
A slipped disc is synonymous with a prolapsed disc or a disc herniation. The cause of this medical condition is when the tough, outer layer of the disc weakens or tears, allowing the soft interior, called nucleus pulposus, to exude out of position thereby placing pressure on the surrounding nerve roots and/or spinal cord which together are protected within the spinal canal formed by the vertebral bones. This herniation of the disc can occur at any level of the spine but most commonly occurs in the neck or low back.
Physical signs and symptoms are associated with a herniated disc or slipped disc and will lead your doctor to suspect this medical condition. A slipped disc cannot be visualized upon physical examination, however, it would be detected on an MRI spine image. Prior to authorizing a MRI, most insurance companies require six (6) weeks of conservative management comprised of documented physical therapy and nonsteroidal anti-inflammatories. If severe conditions are suspected or if pain is intolerable, the CNSO neurosurgeons and orthopedic spine surgeons will demand a one-on-one conversation with the Medical Director of the insurance company to override the six weeks of conservative care requirement.
Symptoms
Slipped discs can cause two types of symptoms:
Local neck or back pain – Because intervertebral discs are part of the specialized joints of the spinal column, a tear in the joint can cause discomfort at the level of the spine in which the joint is located by placing pressure on the nearby spinal nerves and spinal cord. In the cervical spine, a slipped cervical disc can cause neck pain plus parasthesias, such as tingling sensations, down one or both arms and possibly into the hands. If the herniated or slipped disc is a lumbar disc, it can cause low back pain and paresthesias down one or both legs and sometimes into the foot. If there is too much pressure on the spinal nerves, it can cause weakness in the arm or leg and escalate to an inability to move the arm or leg. Weakness should prompt the patient to no longer wait and immediately be seen by a CNSO neurosurgeon or orthopedic spine surgeon. If too much pressure is on the spinal cord, the patient can become weak or paralyzed in both arms and legs, loss bladder and bowel function and permanently become paralyzed. Again, any of these signs or symptoms is an emergency necessitating an immediate surgical action by a CNSO neurosurgeon or orthopedic spine surgeon.
Nerve pain – If the portion of the disc that slips out places pressure on a nearby nerve, symptoms will be felt throughout the parts of the body where the nerve travels, such as an arm or a leg. This “traveling pain” is referred to as radiculopathy. And is caused by the pressure on the nerve root which in layman’s terms is referred to as a pinched nerve. If the pinched nerve causes radiculopathy down the back of a leg, it is often called sciatica. Symptoms can range from mild aches and muscle spasms to excruciating pain that may include numbness, tingling, cramping, or a burning sensation. Symptoms can vary with your activity level and/or movement. Typically, symptoms are limited to one arm or leg, depending on the location of the slipped disc, but can affect both sides if the disc fragment is large.
Severity and symptoms vary greatly from person to person. A trained medical practitioner can help determine the cause of your symptoms and how to best treat them. You should see a doctor if you experience any of the following symptoms:
- Shooting pain in the neck and/or into the arm.
- Shooting pain in the back and/or down the leg.
- Numbness, tingling, or loss of feeling in arm, hands or fingers, legs or feet.
- Muscle weakness of arms, hands, legs, or feet or an inability to move an extremity.
- Numbness around the buttocks or genitals.
- Problems with bowel or bladder control.
Causes
Slipped discs can occur at any age, but most commonly affect people 30 or older. They can happen as a result of the natural aging process, arthritis, spondylosis, or repetitive heavy lifting, lifting with bad technique, spinal deformity, spondylolisthesis poor posture, and trauma to the back or neck.
Risk Factors
Risk factors include obesity, sedentary lifestyle, weakened back muscles, smoking, heavy lifting, bad posture, collision sports, or trauma. Maintaining an active lifestyle and regular workouts helps maintain muscle strength or the erector spine muscles which help to maintain the spinal bones, tendons, and ligaments in alignment. When they are pulled out of alignment by heavy lifting, collision, or trauma, without muscle strength there is no protection against these forces and this is what causes discs to herniate or slip out of position.
Complications
Complications of a slipped disc can vary, depending on the severity and placement. Not all slipped discs will cause symptoms; and in most that do, those symptoms typically improve with time. However, larger ones can cause complications. If left untreated, permanent nerve damage can occur, leading to muscle weakness, loss of sensation, or loss of use of an arm or leg. A very large slipped disc in the lower back can cut off nerve signals to your bowel or bladder. This is considered a medical emergency and requires urgent evaluation by a medical professional otherwise it will result in permanent bilateral paralysis.
Diagnosis
Your trained medical practitioner will review your symptoms and examine you to help identify the cause. They may also order:
- X-rays – can reveal degenerative changes in the bones of your spine, and help identify possible areas of concern.
- MRI scans of the spine show anatomical details of the spine, such as the discs and nerves. MRIs are obtained if the patient displays worrisome findings on exam, or does not get better after initial conservative care such as rest or physical therapy.
- EMG studies help characterize the location and degree of nerve damage if a slipped disc compresses a nerve.
Treatment Options
The majority of patients with symptoms from a slipped disc get better within 6-8 weeks. Therefore, initial treatments are conservative. These include:
- Activity restriction and temporary rest to prevent further damage and reduce inflammation.
- Medications to control pain, relieve spasm, and calm down irritated nerves.
- Physical therapy for muscle and joint mobility, stretching, skeletal stabilization, and postural training.
- Epidural injections to deliver inflammation-reducing steroids to the area of concern.
Surgery is reserved for when the herniation is too large and symptoms are too severe or symptoms do not resolve with any of the above treatment. Surgical options include minimally invasive microdiscectomy, decompressive laminectomy with discectomy, and sometimes decompressive laminectomy with fusion. Following a thorough review of your symptoms, examination, and imaging, a CNSO trained medical professional will help determine what is right for you.
Centers for Neurosurgery, Spine, & Orthopedics Can Help
The dedicated surgical and non-surgical team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how slipped discs can affect your life. By working with recognized board-certified neurosurgeons, physiatrists who are non-surgical physicians and rehabilitation specialists, plus the PhD certified physical therapists, patients receive comprehensive, coordinated care and treatment. CNSO offers multiple convenient locations spanning from Passaic County to Morris County and nearby towns including Clifton, Jersey City, and Parsippany, NJ. Northern NJ patients can learn more about spinal decompression surgery or conservative care, by contacting the doctors at CNSO today.
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