Slipped disc in the back and neck

What is a disc?

Between the bones of the spine (the vertebrae) sit soft cushions called discs. Each disc has a tougher outer wall with a softer centre. When the wall tears or weakens, some of the soft centre can push out. This is called a herniated disc (in everyday speech, a “slipped disc”). Words like bulge, slip or rupture for the same thing.

Most of the time the lower back is affected. The neck can be affected too.

A disc only hurts when it presses on a nearby nerve. Many people have a herniated disc and never know it, because it does not always cause symptoms.

Symptoms

Symptoms depend on where the disc is and how big it is.

• In the lower back: burning, tingling or numbness that runs from the back and buttock down the leg (sciatica), usually on one side. The pain may get worse with standing, walking or sitting.
• In the neck: pain in the neck or shoulder blade that spreads into the arm, hand or fingers, with numbness or tingling. Some neck positions make it worse.
• Muscle weakness in an arm or leg, more so when the nerve is more affected.

Who is this page for?

This page is for people who:

• have back or neck pain together with pain, numbness or weakness in a leg or arm
• have been told by an MRI that they have a disc herniation and want to know what to do
• have tried simple treatments for a few weeks and have not got better

Most people get better without surgery

This is the most important sentence on this page. Most disc problems improve without surgery, and surgery is usually not needed. Sciatica and nerve pain from the neck improve within days to weeks in most patients.

First steps:

• Stay active. Strict bed rest is not recommended. Cut down on heavy activity for the first few days, but keep walking as far as you can manage.
• Pain relief. Anti-inflammatory medicines such as ibuprofen are used for mild to moderate pain, if you have no reason to avoid them. Ask your doctor or pharmacist about the type and dose.
• Physiotherapy. After an assessment, a physiotherapist chooses suitable exercises.
• Epidural injection. If pain continues, a doctor may suggest an injection of medicine near the disc.

More detail is on the “Treatment without surgery” page.

When is surgery considered?

Surgery is discussed when physiotherapy and medicine have not eased the pain and one or more of these apply:

• nerve pain that limits daily life
• leg numbness or weakness that is getting worse
• loss of control of the bladder or bowel (this is an emergency; see “When to call” below)
• difficulty standing or walking
• fairly good general health

If symptoms have not improved with other treatments, or weakness and numbness are getting worse, a doctor can refer the patient to a specialist to talk about surgery. When patient and surgeon decide together, the benefits and the risks are weighed side by side.

What does the operation involve?

The operation depends on where the disc is (lower back or neck) and on the patient. The surgeon explains it before the operation. These are the general approaches:

• In the lower back: through a cut in the back, the surgeon removes part of the bone over the nerve (the lamina) to reach the disc, then removes the part of the disc that presses on the nerve. Sometimes vertebrae are joined together to make them stable. Lumbar decompression surgery usually takes 2 to 4 hours or more and is done under general anaesthetic.
• In the neck: surgery is done from the front or the back of the neck, depending on where the disc is. Sometimes, after the disc is removed, the vertebrae are held together with special implants.
• An artificial disc may be an option for a small group of patients with particular conditions. It does not suit everyone.

This page does not say which method your surgeon uses. Ask at your visit.

Recovery

Every patient is different. Here is an example for lumbar decompression surgery:

• going home usually 2 to 5 days after the operation
• back to work in about 4 to 6 weeks, depending on the job
• full return to normal activities in about 12 weeks
• pain relief medicine may be needed for a few weeks

Your surgeon will write a detailed plan for you. See also the guide pages “Movement and back care after surgery” and “Wound care”.

Risks

Every operation has risks, and your surgeon will talk to you about them before surgery. These are serious but uncommon complications of lumbar decompression surgery:

• a leak of spinal fluid, which may need another operation
• nerve damage, which in rare cases can lead to paralysis (loss of feeling and movement below the waist)
• continuing back pain
• slipping of other vertebrae, which may need another operation

Also keep in mind the risks of any operation under anaesthetic, such as wound infection and a blood clot in the leg. There is also no guarantee surgery will help every patient.

When to call

Call 115 now or go to an emergency department (115 is Iran’s emergency number) if back or leg pain comes with any of these:

• numbness around the anus or genitals
• being unable to pass urine, or leaking urine or stool
• severe or worsening weakness or numbness in both legs

These signs may mean severe pressure on the nerves at the bottom of the spine. The later treatment starts, the greater the chance of lasting damage. Do not drive yourself.

Back or leg pain that began after a car crash or a heavy blow is an emergency too. It is not a sign of pressure on the nerves at the bottom of the spine, but here as well, call 115 at once.

Contact a doctor the same day, or as soon as you can, if:

• weakness in a leg or arm is slowly getting worse
• the pain comes with a fever or feeling unwell
• the pain is worse at night and does not settle with rest
• the pain is not controlled by painkillers, or has not improved for several weeks

The full list of warning signs is in “When should I call urgently?” in the guide section. Every patient’s plan is different; ask your doctor about your own situation.