Disks are the cushions in-between the vertebrae (the bones of the spine). They allow for motion between the vertebrae and act as shock absorbers. At the center of each disk is the nucleus, a soft, jelly-like structure. This is surrounded by the annulus, thicker fibers that keep the nucleus centered in the disk. A herniation occurs when the annular fibers break down and part of the nucleus pushes out of the disk. In many cases, this is the result of repetitive stress on the disk (i.e., overuse). In some cases, it can be the result of a sudden injury (e.g., lifting something too heavy or trauma from a car accident).

The most common initial symptom of a herniated disk is neck or low back pain. For the majority of patients, this will last a few days to a few weeks and then resolve. However, in more severe cases, a part of the disk will push back into the spinal canal and put pressure on the nerves. In the lower back, this will cause pain and/or numbness that extends into the leg and foot. It can also cause weakness. This is often called sciatica, although lumbar radiculopathy is a more accurate term. In the neck, a herniated disk can cause cervical radiculopathy, which is pain, numbness, and/or weakness that extends into the arm and hand.

Most patients with cervical or lumbar radiculopathy will improve within 6-8 weeks. Initial treatments include physical therapy, anti- inflammatory and pain medications, and rest. If these don’t help, Dr. Gebauer may suggest that you consider having an epidural injection. This places a small amount of a steroid medication (an anti- inflammatory) into the spinal canal around the disks and nerves. This does not shrink the disk or relieve the pressure from the nerves, but it can decrease inflammation to help with pain and control the symptoms while the body heals. If non-operative care does not help (or if there is significant weakness or nerve damage), then surgery is an option. The main goal of surgery is to remove the herniated portion of the disk and relieve the pressure from the nerves. Surgery for the low back is generally performed from the back of the spine. It often involves a procedure called a microdiscectomy. Surgery for the neck is usually performed from the front. This is due to the location of the spinal cord (which usually ends in the upper lumbar spine). Common procedures that Dr. Gebauer performs for cervical disk herniations include anterior cervical decompression and fusion (ACDF) or cervical disk replacements (arthroplasty). In very rare cases, large disk herniations can cause severe weakness or problems with bowel or bladder function (incontinence or inability to urinate or have a bowel movement). While this is extremely uncommon, if you are concerned about these symptoms, you should seek emergency medical attention.

Cervical (neck) • Herniated Cervical Disc - KnowYourBack - NASS  • Cervical Radiculopathy (Pinched Nerve) - OrthoInfo - AAOS  • Anterior Cervical Fusion - KnowYourBack - NASS  • Cervical Disk Replacement - OrthoInfo - AAOS  • Cervical Disk Replacement - KnowYourBack - NASS 

Lumbar (low back) • What is the difference between a disc bulge and a herniation? - KnowYourBack - NASS  • Herniated Lumbar Disc - KnowYourBack - NASS  • Herniated Disk in the Lower Back - OrthoInfo - AAOS  • Lumbar Microscopic Discectomy - - KnowYourBack - NASS 