Finally, your neurosurgeon or spinal surgeon will be interested in knowing if you have problems walking, or when you have to empty your bladder or open your bowels. These questions may appear irrelevant, but they are important to ensure there is no significant pressure from the herniated disc on the spinal cord or nerves to the bowels and bladder. A definite diagnosis is made by radiological investigations.
CT scans will usually reveal significant disc prolapses, however these are often not the most reliable tests. An MRI scan is the most accurate test, however small prolapses may be missed, particularly as most of these investigations are performed while you are lying flat — this places less pressure on the disc and may show less bulging than when you are sitting. Other investigations that your neurosurgeon or spinal surgeon may organise include a CT myelogram where dye is injected into the spinal canal and a CT performed , and a nerve sheath injection with local anaesthetic this may confirm exactly which nerve is generating your symptoms.
Typically this process takes weeks, but may take longer. For information and advice on back pain in young people, see the separate leaflet called Back Pain in Children. It is not clear why some people develop a 'slipped' prolapsed disc and not others, even when they do the same job or lift the same sort of objects. It seems that some people may have a weakness in the outer part of the affected disc. Various things may trigger the inner softer part of the disc to squeeze out through the weakened outer part of the disc.
For example, sneezing, awkward bending, or heavy lifting in an awkward position may cause some extra pressure on the disc. In people with a weakness in a disc, this may be sufficient to cause a prolapse. Factors that may increase the risk of developing a prolapsed disc include:. The pain is often severe and usually comes on suddenly. The pain is usually eased by lying still and is often made worse if you move your back, cough or sneeze. Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on trapped by a 'slipped' prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc.
Although the problem is in the back, you feel pain anywhere along the course of the nerve in addition to back pain. Therefore, you may feel pain below your knee as far as your calf or foot. Nerve root pain can range from mild to severe but it is often worse than the back pain. People often describe nerve root pain as a burning pain. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve.
The term sciatica means nerve root pain of the sciatic nerve. The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back.
It travels deep inside the buttock and down the back of the leg. There is a sciatic nerve for each leg. The irritation or pressure on the nerve next to the spine may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. The exact site and type of symptoms depend on which nerve is affected. Cauda equina syndrome is a particularly serious type of nerve root problem that can be caused by a prolapsed disc. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on.
This syndrome can cause low back pain plus:. Cauda equina syndrome needs urgent treatment to stop the nerves to the bladder and bowel from becoming permanently damaged. See a doctor immediately if you develop these symptoms. To read more about this condition, see the separate leaflet called Cauda Equina Syndrome. Research studies where routine back scans have been done on a large number of people have shown that some people have a prolapsed disc without any symptoms.
It is thought that symptoms mainly occur if the prolapse puts pressure on or irritates a nerve. This does not happen in all cases. Some prolapses may be small, or occur away from the nerves and cause minor or no symptoms.
In most cases, the symptoms tend to improve over a few weeks. Research studies of repeated magnetic resonance imaging MRI scans have shown that the bulging prolapsed portion of the disc tends to shrink regress over time in most cases. The symptoms then tend to ease and, in most cases, go away completely.
About 50 out of every people improve within 10 days, and 75 out of a after four weeks. In only about 2 out of every people with a 'slipped' prolapsed disc is the pain still bad enough after 12 weeks that they end up having to have surgery see below. Your doctor will normally be able to diagnose a 'slipped' prolapsed disc from the symptoms and by examining you.
It is the most common cause of sudden back pain with nerve root symptoms. In most cases, no tests are needed, as the symptoms often settle within a few weeks.
After the disc is removed through a discectomy, the spine may need to be stabilized. Spinal fusion often is performed in conjunction with a laminotomy. In more involved cases, a laminectomy may be performed.
In artificial disc surgery, an incision is made through the abdomen, and the affected disc is removed and replaced. Only a small percentage of patients are candidates for artificial disc surgery. The patient must have disc degeneration in only one disc, between L4 and L5, or L5 and S1 the first sacral vertebra. The patient must have undergone at least six months of treatment, such as physical therapy, pain medication or wearing a back brace, without showing improvement.
The patient must be in overall good health with no signs of infection, osteoporosis or arthritis. If there is degeneration affecting more than one disc or significant leg pain, the patient is not a candidate for this surgery. The medical decision to perform the operation from the front of the neck anterior or the back of the neck posterior is influenced by the exact location of the herniated disc, as well as the experience and preference of the surgeon.
A portion of the lamina may be removed through a laminotomy, followed by removal of the disc herniation for the posterior approach. Patients, who are a candidate for posterior surgery, frequently do not need surgical fusion.
For anterior surgery, after the disc is removed, the spine needs to be stabilized. This is accomplished using a cervical plate, interbody device and screws instrumentation. In a select group of candidates, artificial cervical disc is an option vs.
The doctor will give specific instructions after surgery and usually prescribe pain medication. He or she will help determine when the patient can resume normal activities, such as returning to work, driving and exercising. Some patients may benefit from supervised rehabilitation or physical therapy after surgery. Discomfort is expected during a gradual return to normal activity, but pain is a warning signal that the patient might need to slow down.
The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. It usually gets better slowly with rest, gentle exercise and painkillers. Not all slipped discs cause symptoms. Many people will never know they have slipped a disc. Sometimes the pain may be a result of an injury such as a sprain or strain , but often there's no obvious reason.
Back pain is rarely caused by anything serious. If the pain is very bad, you may need to rest at first. But start gentle exercise as soon as you can — it'll help you get better faster.
The type of exercise is not important, just gradually increase your activity level. Alternate painkillers such as ibuprofen and paracetamol.
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