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Herniated Disc (Slipped Disk)

A potentially painful problem in which the hard outer coating of the disk is damaged, allowing the disk's jelly-like center to leak and cause irritation to adjacent nerves.

PubMed Health Glossary
(Source: NIH - National Institute of Arthritis and Musculoskeletal and Skin Diseases)

About Slipped Disks

The spine is made up of a chain of bones called the vertebrae. The front part of each of the vertebrae is called the vertebral body. Soft spinal disks are found between the vertebrae. The disks have a hard, multilayered casing and a gel-like center (nucleus pulposus). It is thanks to these disks that the spine is flexible and we are able to lean forward or to turn our upper body from side to side. They also absorb shocks that are transferred to the spine when we are running or jumping, for instance.

Having a slipped disk means that one of the spinal disks is bulging beyond the edges of the vertebral bodies above and below it. There are three types of slipped disk:

Prolapse: The disk is bulging out between the vertebrae, but its outermost layer is still intact... Read more about Herniated Disc

What works? Research summarized

Evidence reviews

Pain Management Injection Therapies for Low Back Pain [Internet]

Low back pain is common and injections with corticosteroids are a frequently used treatment option. This report reviews the current evidence on effectiveness and harms of epidural, facet joint, and sacroiliac corticosteroid injections for low back pain conditions.

Physical examination for the diagnosis of lumbar radiculopathy due to disc herniation in patients with low‐back pain and sciatica: a systematic review.

Of all patients with back pain, less than 2% will undergo surgery for a herniated disc in the lumbar spine. In back pain patients who also have leg pain (sciatica), doctors and therapists use a physical examination to estimate the probability that the pain is caused by a disc herniation, and to assist the selection of patients for imaging and surgery. We conducted a systematic review to summarize available information on the diagnostic value of different aspects of physical examination. We included 19 different studies in which a wide variety of tests were investigated, such as the straight leg raising test, absence of tendon reflexes, or muscle weakness. The results show that most individual tests carried out during physical examination are not very accurate in discriminating between patients who have, or do not have a herniated disc with sciatica. However, most of the studies were conducted in highly selected patients who had already been referred for surgery, and only one study was carried out in a primary care population. Furthermore, better diagnostic performance of physical examination may be expected when combinations of tests are used, including information from both the patient history and physical examination. However, more research is needed to investigate the performance of such test combinations.

Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review

The effectiveness of surgery in patients with sciatica due to lumbar disc herniations is not without dispute. The goal of this study was to assess the effects of surgery versus conservative therapy (including epidural injections) for patients with sciatica due to lumbar disc herniation. A comprehensive search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to October 2009. Randomised controlled trials of adults with lumbar radicular pain, which evaluated at least one clinically relevant outcome measure (pain, functional status, perceived recovery, lost days of work) were included. Two authors assessed risk of bias according to Cochrane criteria and extracted the data. In total, five studies were identified, two of which with a low risk of bias. One study compared early surgery with prolonged conservative care followed by surgery if needed; three studies compared surgery with usual conservative care, and one study compared surgery with epidural injections. Data were not pooled because of clinical heterogeneity and poor reporting of data. One large low-risk-of-bias trial demonstrated that early surgery in patients with 6-12 weeks of radicular pain leads to faster pain relief when compared with prolonged conservative treatment, but there were no differences after 1 and 2 years. Another large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years. Future studies should evaluate who benefits more from surgery and who from conservative care.

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Summaries for consumers

Physical examination for the diagnosis of lumbar radiculopathy due to disc herniation in patients with low‐back pain and sciatica: a systematic review.

Of all patients with back pain, less than 2% will undergo surgery for a herniated disc in the lumbar spine. In back pain patients who also have leg pain (sciatica), doctors and therapists use a physical examination to estimate the probability that the pain is caused by a disc herniation, and to assist the selection of patients for imaging and surgery. We conducted a systematic review to summarize available information on the diagnostic value of different aspects of physical examination. We included 19 different studies in which a wide variety of tests were investigated, such as the straight leg raising test, absence of tendon reflexes, or muscle weakness. The results show that most individual tests carried out during physical examination are not very accurate in discriminating between patients who have, or do not have a herniated disc with sciatica. However, most of the studies were conducted in highly selected patients who had already been referred for surgery, and only one study was carried out in a primary care population. Furthermore, better diagnostic performance of physical examination may be expected when combinations of tests are used, including information from both the patient history and physical examination. However, more research is needed to investigate the performance of such test combinations.

Rehabilitation after surgery for herniation of the lumbar disc

We reviewed the evidence on the effects of rehabilitation programmes on pain, recovery, function and return to work in people who have had lumbar disc surgery.

The effects of surgical treatments for individuals with 'slipped' lumbar discs

Prolapsed lumbar discs ('slipped disc', 'herniated disc') account for less than five percent of all low‐back problems, but are the most common cause of nerve root pain ('sciatica'). Ninety percent of acute attacks of sciatica settle with non‐surgical management. Surgical options are usually considered for more rapid relief in the minority of patients whose recovery is unacceptably slow.

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More about Herniated Disc

Photo of an adult

Also called: Herniated disk, Slipped disc, Spinal disc herniation, Spinal disk herniation

Other terms to know:
Intervertebral Disc (Spinal Disk), Sciatic Nerve, Sciatica

Related articles:
How the Spine Works

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