A herniated disc can occur in the cervical spine (neck) or lumbar spine (lower back). At right: The top disc has herniated, or "slipped," and is pressing on a nerve. A normal disc is shown at bottom.
A herniated disc is often diagnosed by a physician after a patient complains of back, neck, or extremity pain. The physician will gather history and symptoms and conduct a physical examination. If a slipped disc is suspected, the physician will usually order imaging tests to confirm the diagnosis.
Diagnostic tests may include:
Computerized tomography (CT) is a noninvasive procedure that uses x-rays to produce a three-dimensional image of the spine. A CT scan may show evidence of a ruptured disc.
Magnetic resonance imaging (MRI) scans are the best tools for diagnosing a slipped disc. An MRI uses magnetic fields and radio-frequency waves to create an image of the spine, and can reveal the details of the disc, the nucleus (the jelly-like substance within) and the annulus (the firm outer layer). An MRI scan can also show evidence of previous injuries that may have healed and other details in the spine that can’t normally be seen on an x-ray.
Myelogram: This special x-ray uses dye, which is injected into the spinal fluid. This can identify a ruptured disc. Usually a CT scan follows the myelogram.
Electromyogram and Nerve Conduction Studies (EMG/NCS): This test measures the electrical activity in the nerves and muscles. It may identify if there is nerve damage or nerve compression either in the spine or elsewhere in the arms or legs.
Once a diagnosis has been confirmed, an individual with a herniated disc should be referred to a major spine center for a full evaluation and individual treatment plan.
Treatments for ruptured discs vary, depending on the location and severity of damage. Treatment options are usually quite conservative at first, and can include time, over-the-counter pain medications, steroids, muscle relaxants, occupational therapy,acupuncture and epidural injections. In most cases, the symptoms will resolve within 2-3 months.
If these initial treatments are ineffective and symptoms persist, other options will be considered. The spine team at Weill Cornell Neurological Surgery believes in an interdisciplinary approach to the treatment of ruptured discs, including physiatry, pain management, physical therapy, and — only when necessary, minimally invasive surgery.
Surgery for slipped discs may be recommended if:
- Conservative treatments prove ineffective
- Pain is so severe that it is debilitating
- There is loss of bowel or bladder function
- It is difficult to stand or walk
“Minimally invasive surgery” refers to the advanced techniques that top spine surgeons use to repair a herniated disc.Minimally invasive surgery causes much less trauma than older surgical methods and requires much less time in the hospital. The incision is smaller, and avoids muscle trauma, which allows patients to resume regular activity within a short period of time. Surgery for a herniated disc is best performed at a major spine center with doctors trained and experienced in the most up-to-date, minimally invasive techniques. Minimally invasive surgery means a quick recovery, less pain, and less scarring. (See Surgery for a Herniated Disc.)
