Diagnosis

Herniated disk FAQs

Neurosurgeon Mohamad Bydon, M.D., answers the most frequently asked questions about herniated disks.

Hello. I'm Dr. Mohamad Bydon, a neurosurgeon at Mayo Clinic. I'm here to answer some of the important questions you may have about back and neck pain.

Sleep and stress can both contribute to pain. Sleep is the period during which the body rejuvenates itself. An adequate period of sleep, with good quality of sleep, is very important to manage pain successfully. Stress can also be an exacerbator of pain. Managing stress properly and dealing with it in adequate ways is also a very important component of managing pain.

I commonly get questions about mattresses and pillows. And there's good reason for this. We spend so much time sleeping, that sleep is an important component of our back and neck health. With a mattress, the general idea is to have something of medium firmness. You want something that gives just enough support, but not too much support. A mattress that is too soft will put you back into awkward positions at night and exacerbate painful conditions. A mattress that's too firm will not allow your back and neck to rest and will put pressure on areas of your back and neck. In terms of a pillow, you want one that allows neutral position of your neck. So you don't want your neck overly flexed, you don't want it overly extended. So as long as that pillows maintaining neutral position, then that's a good pillow for you for the way that you sleep.

Arthritis of the neck and back is a common condition. This is known as wear and tear or degenerative disease. They cause back and neck pain. Back pain is the number one reason to see your doctor, neck pain is the number three reason to see your doctor. In our lifetimes, 80% of us will experience back pain so severe that it requires medical attention.

Arthritis cannot be stopped, there is no cure for arthritis, but it can be managed and treated. Core strengthening is very important. Maintaining a good body weight is very important. Building strength, exercise not being sedentary, all of those are things that are very important in helping manage and treating arthritis.

It's important to partner with your medical team to get the best result for your health care condition. The best way to do that is to be informed about your condition. We've provided you with a lot of information today that will allow you to work with your doctor and their medical team. Never hesitate to ask your medical team questions that you may have. Being informed makes all the difference. Thank you for your time and we wish you well.

During the physical exam, your doctor will check your back for tenderness. You might be asked to lie flat and move your legs into various positions to help determine the cause of your pain.

Your doctor may also perform a neurological exam to check your:

  • Reflexes
  • Muscle strength
  • Walking ability
  • Ability to feel light touches, pinpricks or vibration

In most cases of herniated disk, a physical exam and a medical history are all that's needed for a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests.

Imaging tests

  • X-rays. Plain X-rays don't detect herniated disks, but they can rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
  • CT scan. A CT scanner takes a series of X-rays from different directions and then combines them to create cross-sectional images of the spinal column and the structures around it.
  • MRI. Radio waves and a strong magnetic field are used to create images of the body's internal structures. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.
  • Myelogram. A dye is injected into the spinal fluid before a CT scan is taken. This test can show pressure on the spinal cord or nerves due to multiple herniated disks or other conditions.

Nerve tests

Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of nerve damage.

  • Nerve conduction study. This test measures electrical nerve impulses and functioning in the muscles and nerves through electrodes placed on the skin. The study measures the electrical impulses in nerve signals when a small current passes through the nerve.
  • Electromyography (EMG). During an EMG, a doctor inserts a needle electrode through the skin into various muscles. The test evaluates the electrical activity of muscles when contracted and when at rest.

More Information

Treatment

Conservative treatment — mainly modifying activities to avoid movement that causes pain and taking pain medication — relieves symptoms in most people within a few days or weeks.

Medications

  • Nonprescription pain medications. If your pain is mild to moderate, your doctor might recommend pain medication available without a prescription, such as acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
  • Neuropathic drugs. These drugs affect nerve impulses to decrease the pain. They include gabapentin (Gralise, Horizant, Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta, Drizalma Sprinkle), or venlafaxine (Effexor XR).
  • Muscle relaxers. You might be prescribed these if you have muscle spasms. Sedation and dizziness are common side effects.
  • Opioids. Because of the side effects of opioids and the potential for addiction, many doctors hesitate to prescribe them for disk herniation. If other medications don't relieve your pain, your doctor might consider short-term use of opioids, such as codeine or an oxycodone-acetaminophen combination (Percocet, Oxycet). Sedation, nausea, confusion and constipation are possible side effects from these drugs.
  • Cortisone injections. If your pain doesn't improve with oral medications, your doctor might recommend a corticosteroid that can be injected into the area around the spinal nerves. Spinal imaging can help guide the needle.

Therapy

Your doctor might suggest physical therapy to help with your pain. Physical therapists can show you positions and exercises designed to minimize the pain of a herniated disk.

Surgery

Few people with herniated disks require surgery. Your doctor might suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to have:

  • Poorly controlled pain
  • Numbness or weakness
  • Difficulty standing or walking
  • Loss of bladder or bowel control

In nearly all cases, surgeons can remove just the protruding portion of the disk. Rarely, the entire disk must be removed. In these cases, the vertebrae might need to be fused with a bone graft.

To allow the process of bone fusion, which takes months, metal hardware is placed in the spine to provide spinal stability. Rarely, your surgeon might suggest the implantation of an artificial disk.

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Lifestyle and home remedies

Besides taking the pain medications your doctor recommends, try:

  • Applying heat or cold. Initially, cold packs can be used to relieve pain and inflammation. After a few days, you might switch to gentle heat to give relief and comfort.
  • Avoiding too much bed rest. Staying in bed can lead to stiff joints and weak muscles — which can complicate your recovery. Instead, rest in a position of comfort for 30 minutes, and then go for a short walk or do some work. Try to avoid activities that worsen your pain.
  • Resuming activity slowly. Let your pain guide you in resuming your activities. Make sure your movements are slow and controlled, especially bending forward and lifting.

Alternative medicine

Some alternative and complementary medicine treatments might help ease chronic back pain. Examples include:

  • Chiropractic. Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.
  • Acupuncture. Although results are usually modest, acupuncture appears to ease chronic back and neck pain.
  • Massage. This hands-on therapy can provide short-term relief to people dealing with chronic low back pain.

Preparing for your appointment

You're likely to start by seeing your family doctor. You might be referred to a doctor specializing in physical medicine and rehabilitation, orthopedic surgery, neurology, or neurosurgery.

What you can do

Before your appointment, be prepared to answer the following questions:

  • When did your symptoms start?
  • Were you lifting, pushing or pulling anything at the time you first felt symptoms? Were you twisting your back?
  • Has the pain kept you from participating in activities?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What medications or supplements do you take?

What to expect from your doctor

Your doctor might ask other questions, including:

  • Does your pain travel into your arms or legs?
  • Do you feel weakness or numbness in your arms or legs?
  • Have you noticed changes in your bowel or bladder habits?
  • Does coughing or sneezing worsen your pain?
  • Is the pain interfering with sleep or work?
  • Does your work involve heavy lifting?
  • Do you smoke or use other tobacco products?
  • How has your weight changed recently?
Feb. 08, 2022
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  3. AskMayoExpert. Lumbar radiculopathy (adult). Mayo Clinic. March 25, 2021.
  4. Herniated disk in the lower back. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back/. Accessed July 30, 2021.
  5. Herniated nucleus pulposus. Merck Manual Professional Version. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/neck-and-back-pain/herniated-nucleus-pulposus?query=herniated disk#. Accessed July 31, 2021.
  6. Hsu PS, et al. Acute lumbosacral radiculopathy: Pathophysiology, clinical features and diagnosis. https://www.uptodate.com/contents/search. Accessed July 31, 2021.
  7. Wu PH, et al. Intervertebral disc diseases part 2: A review of the current diagnostic and treatment strategies for intervertebral disc disease. International Journal of Molecular Sciences. 2020; doi:10.3390/ijms21062135.

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