Herniated Disk

Diagnosis

To diagnose a herniated disk, your healthcare professional will perform a physical and neurological exam to check for pain, nerve involvement, and muscle function. During the physical exam, you may be asked to move your legs into different positions to determine the source of your pain.

A neurological exam is also performed to check:

• Reflexes

• Muscle strength

• Walking ability

• Sensation to touch, pinpricks, or vibration

In most cases, a physical exam and medical history are enough for diagnosis. However, if another condition is suspected or the affected nerves need to be identified, imaging and nerve tests may be recommended.

Imaging tests include:

• X-rays: Help rule out infections, tumors, spinal alignment problems, or fractures.

• CT scan: Creates detailed cross-sectional images of the spinal column and surrounding structures.

• MRI: Provides clear images of the spine to confirm the location of the herniated disk and identify affected nerves.

• Myelogram: Uses a dye injected into spinal fluid before a CT scan to show pressure on the spinal cord or nerves.

Nerve tests include:

• Nerve conduction study: Measures how electrical impulses move through nerves and muscles using electrodes placed on the skin.

• Electromyogram (EMG): Evaluates the electrical activity of muscles during rest and contraction using a fine needle electrode.

Treatment

Treatment for a herniated disk focuses on relieving pain, improving mobility, and preventing further injury. Most people improve within a few days or weeks using conservative treatments.

Conservative treatment options include:

• Avoiding movements that worsen pain

• Taking pain-relief medicines as directed

Medications commonly prescribed:

• Nonprescription pain medicines such as acetaminophen, ibuprofen, or naproxen sodium

• Neuropathic drugs like gabapentin, pregabalin, duloxetine, or venlafaxine to reduce nerve-related pain

• Muscle relaxers to ease spasms, though they may cause dizziness or sedation

• Opioids, used only short-term for severe pain when other medicines fail

• Cortisone injections to reduce inflammation around the affected nerves if oral medicines don’t help

Therapy:
Physical therapy is often recommended to strengthen the back muscles and improve posture. A therapist can teach you exercises and positions that help relieve pressure and pain caused by a herniated disk.

Surgery:
Surgery is rarely needed but may be considered if:

• Pain remains severe after six weeks of conservative treatment

• There is numbness or weakness

• Walking or standing becomes difficult

• Bladder or bowel control is affected

Most surgeries involve removing only the herniated portion of the disk. In rare cases, the entire disk may need to be removed and the vertebrae fused with a bone graft for stability. Metal hardware or an artificial disk may also be used to maintain spinal support and mobility.