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What is a Herniated Disk

What is a herniated disk (Ruptured, Slipped Disk)?

A disk herniation is a hole or tear in the fibrocartilaginous material that engulfs the intervertebral disk. The center of the intervertebral disk or the nucleus pulposus, when compressed by the vertebrae above and below it, is forced out. The nucleus pulposus places pressure on the spinal nerves. A herniated disk most often occurs in the low back. However, a herniated disk can occur in the cervical and thoracic areas of the spoine.

Anatomy of the spine

The spinal cord is comprised of 26 vertebrae. These vertebrae are joined together and allow the spine to bend forwards and backwards, side to side and the ability for the upper body to rotate. There are five areas of the spine which include the cervical or neck area, thoracic or chest region, the lumbar or low back region, and the sacral and coccygeal or tail bone region of the spine. The cervical region of the spine is comprised of seven vertebrae, twelve vertebrae make up the thoracic area of the spine and the lumbar region contains five vertebrae. The sacrum is composed of five fused vertebrae, which are connected to four fused vertebrae forming the coccyx. Intervertebral disks lie between each adjacent vertebra.While several factors such as age, gender and work environment may contribute to the possibility of a disk herniation, a severe impact to the spine, such as that which occurs in an automobile accident, can cause a herniated disk. Prolonged exposure to be being bent over can cause a herniation as well as the improper lifting of a heavy item.

There are four classifications of disk pathology:

  1. Protrusion- This occurs when a disk bugles without actually rupturing.
  2. Prolapsed disk- A prolapsed disk is when the nucleus pulposus migrates to the outermost fibers of the annulus fibrosis.
  3. Extrusion- A disk extrusion occurs when the annulus fibrosis perforates and material of the nucleus moves into the epidural space.
  4. Sequestered disk- A sequestrated disk occurs when fragments from the annulus fibrosis and nucleus pulposus are outside the disk proper.

Pressure from the spinal vertebrae can cause the disk to push its fluid into the vertebral body. The annulus could weaken over time, allowing stretching or tearing and leading to a disk herniation. If a herniation presses directly on the nerve root or on the spinal cord itself, it can cause shock-like pain (sciatica) down the legs, weakness, numbness, or problems with bowels, bladder, or sexual function.

Diagnosis of a herniated disk (Ruptured, Slipped Disk)

There are several tests available that are useful in diagnosing a herniated disk as well as the location of the herniation:

  • Myelogram- Dye or air is injected into the spinal canal. This allows a special x-ray to take pictures of your bones and the space in between. A dye is injected by a needle into the suarachnoid space so that the nerve roots and spinal cord can be seen more clearly. An x-ray of the spine is taken before the dye and then after
  • CAT Scan- A CAT scan or CT scan is a computer generated x-ray that produces cross sectional and three dimensional image
  • Electromyogram- An electromyogram or EMG is used to record the electrical activity of the muscles. During an emg small solid needles are injected into the muscle to measure the electrical activity. A nerve conduction study may be conducted along with an EMG.
  • Magnetic Resonance Imaging- Magnetic Resonance Imaging or MRI, is a radiology technique that uses radio waves and magnetism to produce images of the body's structures. The images produced by an MRI are very detailed and can detect even the slightest of change within the body's structures.
  • Myelography- a type of x-ray that uses dye injected in the space around the spinal cord to more clearly outline the space containing the spinal cord, the nerves, and show any disk herniation.

It is not uncommon for a herniated disk to be diagnosed as a severe strain or sprain. If your symptoms persist, you should see your doctor so that he or she can  prescribe treatment that will properly diagnose and treat your back problems.

Treatment of a herniated disk (Rupture, Slipped Disks)

There are different types of recommended treatment for a herniated disk. Treatments very depending on the severity of your symptoms. Your doctor may prescribe anti-inflammatory medication to reduce the inflammation caused by the herniation in addition to muscle relaxers to reduce muscle spasms. If oral medications do not provide any relief your doctor may recommend a steroid injection to reduce pain and inflammation. Your doctor may also prescribe bed rest during periods in which your symptoms are most severe.

For a herniated disk in the neck, your doctor may prescribe a neck brace which will help eliminate pressure on the cervical spine. Traction is also used to alleviate pressure. Traction is most commonly used for herniated disks in the cervical spine.

Your doctor may also prescribe physical therapy which uses specific exercises to alleviate the pressure on the spine and to strengthen both your muscles in your back as well as around your core. These exercises are designed to increase strength and mobility. By strengthening the muscles in your back, you eliminate the pressure on the spine.

Surgical repair of herniated disk

Surgical intervention is usually the last option a person may have in relieving their pain symptoms associated with a herniated disk. If your doctor recommends surgery, we recommend getting a second opinion to ensure that you have no other options.

There are several different types of surgical approaches for treating an/or repairing a herniated disk:

  • Discectomy- A discectomy is when the surgeon removes the part of the disk that is pressing on the nerve causing the back pain.
  • Laminotomy and Laminectomy- These procedures are performed to relieve pressure on the spine cord and or nerve roots. Laminotomy removes a part of the lamina which is the thin part of the vertebrae that forms a protective arch of the spinal cord. A laminectomy removes the entire lamina on selected vertebrae. The surgeon may also remove the tissue that is causing narrowing of the spinal canal. These procedures may also be done along with a discectomy.
  • Microdiscectomy- The surgeon will use a microscope to remove the disk tissue or lamina until the pressure is removed from the nerve root. This procedure can be done using local anesthetic and a smaller incision than a standard discectomy making the procedure less invasive.
  • Spinal Fusion- A spinal fusion is a procedure in which the surgeon removes a bone graft, usually from the pelvis area and places it between the vertebrae after the disk material has been removed. A spinal fusion is usually performed when the disk herniation is too large to repair and the patient has severe back pain. The surgeon may completely remove the disk to keep a herniation from recurring after the fusion. A spinal fusion surgery usually requires the patient to wear a back brace to immobilize the back until the spine has fused together. This can take up to several months.

Prognosis for herniated disks (Ruptured, Slipped Disks)

Up to 95% of all back injury cases result in surgery. A majority of patients with herniated disks respond well to conservative treatment.

Of the 5% to 10% of patients who do require surgical intervention, various studies reveal a 60% to 90% success rate. Of course each surgical procedure is not without risk. Anytime surgery is prescribed as a treatment option, it is recommended that you get a second opinion.

Only you and your doctors can decide on what treatment option is best for your. 

At Donald W. Fohrman & Associates, Ltd., our experienced injury attorneys have handled numerous cases involving work related back injury cases.   Call 888-861-2510 if you would like to receive a free, no obligation consultation or use our Free Case Evaluation submission form.