Herniated disk

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	Bones of the spine	Herniated disk repair
Sciatic nerve

Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk; Herniated nucleus pulposus

Low back or neck pain can vary widely. It may feel like a mild tingling, dull ache, or a burning or pulsating sensation. In some cases, the pain is severe enough that you are unable to move. You may also have numbness.

The pain most often occurs on one side of the body.

• With a lumbar (lower back) herniated disk, you may have sharp pain in one part of the leg, hip, or buttocks and numbness in other parts. You may also feel the sensations on the back of the calf or sole of the foot. The affected leg may feel weak.
• With a cervical (neck) disk herniation, you may have pain when moving your neck, deep pain near or over the shoulder blade, or pain that radiates to the upper arm, forearm, or (rarely) fingers.

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The pain often starts slowly. It may get worse:

• After standing or sitting
• At night
• When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards, especially if it is caused by spinal stenosis

You may also have weakness in certain muscles. Sometimes, you may not notice it until your doctor examines you. In other cases, you will notice that you have a hard time lifting your leg or arm, standing on your toes on one side, squeezing tightly with one of your hands, or other problems.

The pain, numbness, or weakness often will go away or improve a lot over a period of weeks to months.

A physical examination and history of pain may be all that your health care provider needs to diagnose a herniated disk. A neurological examination will evaluate muscle reflexes, sensation, and muscle strength. Often, examination of the spine will reveal a decrease in the spinal curvature in the affected area.

Leg pain that occurs when you sit down on an exam table and lift your leg straight up usually suggests a herniated lumbar disk.

A foraminal compression test of Spurling is done to diagnose cervical radiculopathy. For this test, you will bend your head forward and to the sides while the health care provider puts slight downward pressure on the top of your head. Increased pain or numbness during this test is usually a sign of cervical radiculopathy.

DIAGNOSTIC TESTS

• Spine x-ray may be done to rule out other causes of back or neck pain. However, it is not possible to diagnose a herniated disk by spinal x-ray alone.
• Spine MRI or spine CT will show spinal canal compression by the herniated disk.
• EMG may be done to determine the exact nerve root that is involved.
• Nerve conduction velocity test may also be done.
• Myelogram may be done to determine the size and location of disk herniation.

Review Date: 05/25/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery (7/10/2009).

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).