Herniated nucleus pulposus (slipped disk)

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Herniated disk repair	Herniated nucleus pulposus	Lumbar spinal surgery - series	Sciatic nerve
Skeletal spine

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

SYMPTOMS OF HERNIATED LUMBAR DISK

• Severe low back pain
• Pain radiating to the buttocks, legs, and feet
• Pain made worse with coughing, straining, or laughing
• Tingling or numbness in legs or feet
• Muscle weakness or atrophy in later stages
• Muscle spasm

SYMPTOMS OF HERNIATED CERVICAL DISK

• Neck pain , especially in the back and sides
• Deep pain near or over the shoulder blades on the affected side
• Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
• Pain made worse with coughing, straining, or laughing
• Increased pain when bending the neck or turning head to the side
• Spasm of the neck muscles
• Arm muscle weakness

A physical examination and history of pain may be all that is needed 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 provides slight downward pressure to the top of the head. Increased pain or numbness during this test is usually indicative of cervical radiculopathy.

DIAGNOSTIC TESTS

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

Review Date: 05/31/2006
Reviewed By: Kevin B. Freedman, MD, MSCE, Sports Medicine, Orthopaedic Specialists, Bryn Mawr, PA. Review provided by VeriMed Healthcare Network.