Herniated Disc (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Herniated disc facts
- How are the spine and its discs designed?
- What is a herniated disc? What causes it?
- What are symptoms of a herniated disc?
- How is a herniated disc diagnosed?
- How is a herniated disc treated?
- What is the prognosis (outlook) for a herniated disc?
- Can a herniated disc be prevented?
- Find a local Orthopedic Surgeon in your town
What are symptoms of a herniated disc?
The symptoms of a herniated disc depend on the exact level of the spine where the disc herniation occurs and whether or not nerve tissue is being irritated. A disc herniation may not cause any symptoms. However, disc herniation can cause local pain at the level of the spine affected.
If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation. This can cause shooting pain in the distribution of that nerve and usually occurs on one side of the body, referred to as sciatica. For example, a disc herniation at the level between the fourth and fifth lumbar vertebrae of the low back can cause a shooting pain down the buttock into the back of the thigh and down the leg. Sometimes this is associated with numbness and tingling in the leg. The pain often is worsened upon standing and decreases with lying down.
If the disc herniation is extremely large, it can press on spinal nerves on both sides of the body. This can result in severe pain down one or both lower extremities. There can be marked weakness of the lower extremities and even incontinence of bowel and bladder. This is medically referred to as cauda equina syndrome.
How is a herniated disc diagnosed?
The doctor will suspect a herniated disc when symptoms described above are present. The neurologic examination can reveal abnormal reflexes. Often pain can be elicited when the straight leg is raised when lying or sitting. This is referred to as a "positive straight leg raising test." There can be abnormal sensation in the foot or leg.
A variety of blood tests are frequently done to determine if there are signs of inflammation or infection.
Plain film X-rays can indicate "wear and tear" (degeneration) of the spine. They do not, however, demonstrate the status of discs. In order to determine whether or not a disc is herniated, an MRI scan or CT scan is performed for diagnosis. Sometimes a myelogram is used to further define the structures affected by a herniated disc.
An electromyogram (EMG) can be used to document precisely which nerves are being irritated by a disc herniation.
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