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  Back Pain Slideshow

Back pain conditions are very common. Learn the truth and get the facts behind myths, remedies, causes and treatment for back pain.

CAT Scan

A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.

Cortisone Injection

Cortisone injections are used to treat small areas of inflammation or widespread inflammation throughout the body. There is minimal pain from these injections, and relief from the pain of inflammation occurs rapidly.

Degenerative Disc

Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.

Discogram

As we age, or become injured, the vertebral discs can become damaged and/or shrink, which causes pain. A discogram is used to determine if a particular vertebral disc is the source of pain. Discograms attempt to reproduce rather than remove pain to help determine if injury to a particular disc is the source of a person's pain. The information gathered from the discogram can lead to the diagnosis of a particular disc injury so the doctor can determine treatment options for relief of the pain.

Electromyogram

Electromyogram or EMG is defined as a test that records the electrical activity of muscles. Normal muscles produce a typical pattern of electrical current that is usually proportional to the level of muscle activity. Diseases of muscle and/or nerves can produce abnormal electormyogram patterns.

Low Back Pain

There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

Low Back Pain Slideshow

Do you suffer from low back pain? Watch this slideshow to see common triggers of lower back pain and what kind of treatments you can get to help find relief.

MRI Scan

MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.

Neck Pain

Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.

Pain Management

Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:

complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.

Sciatica

Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica.

Sciatica Slideshow

Sciatica pain radiates from the lower back toward the feet. Sciatica may feel like a cramp in the leg, burning, tingling, pins and needles, or numbness. Learn about sciatica causes, exercises, treatment and pain relief.

Slipped Disc Picture

Rupturing of the tissue that separates the vertebral bones of the spinal column. See a picture of Slipped Disc and learn more about the health topic.

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Herniated Disc

What's a Herniated Disc, Pinched Nerve, Bulging Disc...?

What's a Herniated Disc, Pinched Nerve, Bulging Disc...?

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By Colin Haines, M

Peer Reviewed

Many terms may be used to describe issues with a spinal disc and disc pain, and all may be used differently and, at times, interchangeably. Some commonly used terms include:

Herniated disc

Pinched nerve

Ruptured/torn disc

Bulging disc

Disc protrusion

Slipped disc

herniated disc and pinched nerve

A herniated disc occurs when inflammatory proteins from a disc's inner core leak out.

Watch: Herniated Disc Video

There is no main consensus on the use of these terms, and it can be frustrating to hear one diagnosis described in many different ways.

Article continues below

The medical diagnosis identifies the underlying cause of back pain, leg pain, and other symptoms. It is more useful to gain a clear understanding of the medical diagnosis than to sort through various medical terms.

In This Article:

What's a Herniated Disc, Pinched Nerve, Bulging Disc...?

Diagnosing Disc Problems

Herniated Disc vs. Degenerative Disc Disease Treatments

Herniated Disc Video

Two Causes of Pain: Pinched Nerve vs. Disc Pain

There are two main ways a spinal disc can cause pain:

Herniated Disc Video Library

Watch Herniated Disc Videos

Pinched nerve. In most cases a herniated disc itself is not painful, but rather the material leaking out of the disc pinches, inflames, or irritates a nearby nerve, causing radicular pain. Radicular pain (also called nerve root pain), describes sharp, shooting pains that radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is commonly called sciatica.

Disc pain. A spinal disc itself may be the source of pain if it dehydrates or degenerates to the point of causing pain and instability in the spinal segment (called degenerative disc disease). Degenerative disc pain tends to include a chronic, low-level pain around the disc and occasional episodes of more severe pain.

Article continues below

A herniated disc and degenerative disc disease typically occur in the cervical spine (neck) and lumbar spine (lower back). Disc pain tends to be most common in the lower back, where most of the movement and weight-bearing in the spine occurs. These conditions are uncommon in the mid-back (the thoracic spine).

Next Page: Diagnosing Disc Problems

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Herniated Disk

Herniated Disk

Also called: Bulging disk, Compressed disk, Herniated intervertebral disk, Herniated nucleus pulposus, Prolapsed disk, Ruptured disk, Slipped disk

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Diagnosis and Tests

Treatments and Therapies

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Related Issues

Specifics

Genetics

Your backbone, or spine, is made up of 26 bones called vertebrae. In between them are soft disks filled with a jelly-like substance. These disks cushion the vertebrae and keep them in place. As you age, the disks break down or degenerate. As they do, they lose their cushioning ability. This can lead to pain if the back is stressed.

A herniated disk is a disk that ruptures. This allows the jelly-like center of the disk to leak, irritating the nearby nerves. This can cause sciatica or back pain.

Your doctor will diagnose a herniated disk with a physical exam and, sometimes, imaging tests. With treatment, most people recover. Treatments include rest, pain and anti-inflammatory medicines, physical therapy, and sometimes surgery.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Start Here

Herniated Disk (American Academy of Family Physicians) Also in Spanish

Diagnosis and Tests

Computed Tomography (CT) - Spine (American College of Radiology, Radiological Society of North America) Also in Spanish

Discography (Discogram) (American College of Radiology, Radiological Society of North America) Also in Spanish

Magnetic Resonance Imaging (MRI) - Spine (American College of Radiology, Radiological Society of North America) Also in Spanish

Radiographic Assessment for Back Pain (North American Spine Society)

Treatments and Therapies

Artificial Disc Replacement (North American Spine Society)

Epidural Injections for Spinal Pain (American College of Radiology, Radiological Society of North America) Also in Spanish

Laparoscopic Spine Surgery (Society of American Gastrointestinal Endoscopic Surgeons)

Lumbar (Open) Microscopic Discectomy (North American Spine Society)

Spinal Fusion (North American Spine Society)

Related Issues

Cervical Radiculopathy (Pinched Nerve) (American Academy of Orthopaedic Surgeons) Also in Spanish

Specifics

Herniated Cervical Disc (North American Spine Society)

Herniated Disk in the Lower Back (American Academy of Orthopaedic Surgeons) - PDF

Herniated Lumbar Disc (North American Spine Society) Also in Spanish

Genetics

Genetics Home Reference: intervertebral disc disease From the National Institutes of Health (National Library of Medicine)

Images

Lumbar spinal surgery - slideshow (Medical Encyclopedia) Also in Spanish

Spinal fusion - slideshow (Medical Encyclopedia) Also in Spanish

Spinal surgery -- cervical - slideshow (Medical Encyclopedia) Also in Spanish

Videos and Tutorials

Herniated nucleus pulposus (slipped disk) Video (Medical Encyclopedia) Also in Spanish

Clinical Trials

ClinicalTrials.gov: Intervertebral Disc Displacement From the National Institutes of Health (National Institutes of Health)

Journal Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine)

Article: Epidural versus intravenous steroids application following percutaneous endoscopic lumbar discectomy.

Article: Full-endoscopic discectomy via the interlaminar approach for disc herniation at...

Article: Bacterial biofilms: a possible mechanism for chronic infection in patients...

Herniated Disk -- see more articles

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National Institute of Arthritis and Musculoskeletal and Skin Diseases From the National Institutes of Health Also in Spanish

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Herniated disk (Medical Encyclopedia) Also in Spanish

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Causes and treatment of a herniated disk

Last updated Mon 22 January 2018

By Tim Newman

Reviewed by William Morrison, MD

Treatment Surgery Causes Symptoms Complications Diagnosis Prevention

A herniated disk, also known as a slipped disk or disk prolapse, is a common condition that can be painful and debilitating.

In some cases, it can lead to numbness or weakness in one or more limbs, but some people experience no pain, particularly if the disk does not press on any nerves.

Symptoms normally reduce or resolve after a number of weeks, but surgery may be needed if they persist or get worse.

In this article, we will discuss what a herniated disk entails, its diagnosis, treatment, and prevention.

Fast facts on herniated disks

Here are some key points about herniated disks. More detail is in the main article.

A herniated disk affects the vertebrae.

Any pain normally goes away within 4 to 6 weeks.

Herniated disks may cause few or no symptoms.

Treatments include medication, physical therapy, ultrasound, and surgery.

Treatment

[Man with back pain]

Recovery normally takes around 4 weeks with treatment.

Herniated disks can be painful, but the right treatment can relieve symptoms.

Most people who experience a herniated disk will recover within 4 weeks.

Symptoms can mostly be resolved by avoiding the types of movement that trigger pain and by following exercise and pain medication regimens.

Treatment options include medication, therapy, and surgery.

Medication

Over-the-counter medication (OTC): Ibuprofen- or naproxen-based drugs can help with mild to moderate pain.

Nerve pain medications: Medications for treating nerve pain include gabapentin, pregabalin, duloxetine, and amitriptyline.

Narcotics: Codeine, an oxycodone-acetaminophen combination, or another type of narcotic can be prescribed if OTC medications do not relieve discomfort. Side effects include nausea, sedation, confusion, and constipation.

Cortisone injections: These can be injected directly into the troubled area to help reduce inflammation and pain. Steroid medications should be used sparingly because of their adverse effects.

Epidural injections: Injected into the epidural space—an area around the spinal cord—steroids, anesthetics, and anti-inflammatory medications can help minimize pain and swelling in and around spinal nerve roots.

Muscle relaxants: These help reduce muscle spasms. Dizziness and sedation are common side effects.

Physical therapy

Physical therapists help find positions and exercises that minimize the pain caused by the herniated disk.

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Therapists may also recommend:

treatment with heat or ice

ultrasound, where using high-frequency sound is to stimulate the affected area and improve blood flow

traction, using ropes, weights, and pulleys to apply force to tissues

short-term bracing for the neck or lower back to improve support

electrotherapy, as electric impulses might reduce pain for some people

Surgery

[Surgeons working on patient]

Surgery is only called for to treat a herniated disk if symptoms persist.

If symptoms do not improve with other treatments, if numbness persists, or if bladder control or mobility worsens, surgery may be recommended.

In most cases, only the protruding portion of the disk is removed. This is referred to as an open discectomy.

It is often conducted using a laparoscopic technique. The surgeon opens a small hole in the abdomen and approaches the spine from the front of the body.

This technique avoids the need to remove small portions of the vertebrae or to move the spinal nerves and spinal cord to get access to the disc.

Less commonly, the entire disk might need to be removed. Normally, metal supports will need to be inserted between the remaining disks to ensure spinal stability.

Artificial disk replacement

Disk replacement procedures have been carried out since the 1980s in Europe but are not yet available in the United States.

There are two types. The first is a total disk replacement. The second is a disk nucleus replacement that involves replacing just the soft center of the disk, known as the nucleus.

Artificial disks are constructed of metal, biopolymer (a plastic-like substance), or both.

Herniated disks are typically manageable without requiring an invasive procedure.

Causes

[Woman with glowing red spine]

Herniated disks are often caused by wear and tear.

The human backbone, or spine, consists of 26 bones called vertebrae. Between each vertebra lie rubbery, cushion-like pads referred to as "disks." These disks help keep the vertebrae in place and act as shock absorbers.

Spinal disks have been likened to doughnuts with a soft, jelly center and a tougher exterior.

A herniated disk occurs when some of the soft interior slips out through a crack in the disk's wall. Most commonly, this occurs in the back, but it can also happen in the vertebrae of the neck.

The escape of this "jelly" is thought to release chemicals that directly irritate nerves in the surrounding area and cause significant pain. The prolapsed disk may also press up against nerves and cause pain through compression.

Often, the cause is wear, due to repeated movement over time.

With age, spinal disks lose some of their water content. This reduction in fluid leaves the disks less supple and more liable to split.

It is not always possible to recall the exact point when a problem with a disk begins, but it often occurs when lifting objects without bending at the knee or twisting when lifting a heavy item.

Risk factors

Herniated disks can happen at any age, but they are most common for individuals in their 20s and 30s.

Factors that increase the likelihood include:

Weight: Being overweight puts additional stress on the lower back

Genetics: A predisposition to herniated disks might be inherited

Occupation: Individuals with physically demanding jobs or pastimes that involve pushing, pulling, or twisting

Symptoms

[Skeleton experiencing back pain]

Herniated disks are also referred to as slipped disks.

In some cases, a person will have no symptoms.

If symptoms do occur, they can include:

Numbness and tingling in the region of the body supplied by the affected nerve.

Weakness in the muscles being supplied by the affected nerve, which may cause stumbling when walking.

Pain in the back, shoulders or arms.

If the herniated disk is in the lower back, the pain often affects the buttocks, thighs, calves, and, possibly, the feet. This is often referred to as sciatica because the pain travels along the path of the sciatic nerve.

If the problem occurs in the neck, the pain normally affects the shoulders and arms. Quick movements or sneezing might induce shooting pains.

One small study on symptom-free volunteers found that 50 percent had some degree of herniated disk that did not cause them any discomfort

All about degenerative disc disease

All about degenerative disc disease

Find out what happens to the disks as we age

Below the waistline, the spinal cord separates into individual nerves, collectively referred to as the cauda equina or "horse's tail."

Rarely, this entire set of nerves can become compressed.

This can cause permanent weakness, paralysis, loss of bowel and bladder control, and sexual dysfunction. If this occurs, emergency surgery is the only option.

Seek medical advice if:

there is any bladder or bowel dysfunction

the weakness progresses and prevents normal activities

numbness around the inner thighs, back of legs, and rectum (saddle anesthesia) gets progressively worse

Diagnosis

Often, a doctor can diagnose a herniated disk with a physical exam.

They may check:

reflexes

possibility of tender regions in the back

muscle strength

range of motion

walking ability

sensitivity to touch

An X-ray can help rule out other conditions with similar symptoms. Other types of imaging can provide more detail as to the whereabouts of the herniated disk:

MRI or CT images can pinpoint the location of the disk and the affected nerves.

Discogram (discography) involves injecting dye into the soft center of one or more disks to help pinpoint cracks in individual disks.

A myelogram involves injecting dye into the spinal fluid and then taking an x-ray image. This can show if there is pressure on the spinal cord and nerves due to herniated disks.

Prevention

Tips for preventing a herniated disk include:

avoid obesity and excess weight, or lose weight if necessary

learn correct techniques for lifting and handling

rest and seek help if symptoms occur, to prevent them from worsening

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MedicineNet.com

The discs are pads that serve as "cushions" between the vertebral bodies, which minimize the impact of movement on the spinal column.

Each disc is designed like a jelly donut with a central softer component (nucleus pulposus).

Abnormal rupture of the central portion of the disc is referred to as a disc herniation.

The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumbar vertebrae in the low back.

If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation.

The physical examination, imaging tests, and electrical tests can aid in the diagnosis of a herniated disc.

Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medication, anti-inflammation medications, local injection of cortisone (epidural injections), and surgical operations.

How are the spine and its discs designed?

The vertebrae are the bony building blocks of the spine. Between each of the largest parts (bodies) of the vertebrae are the discs. Ligaments are situated around the spine and discs. The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back (thoracic vertebrae), and five vertebrae in the low back (lumbar vertebrae). In addition, in the mid-buttock, beneath the fifth lumbar vertebra, is the sacrum, followed by the tailbone (coccyx).

The bony spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a spinous process, which is a bony prominence behind the spinal cord that shields the cord's nerve tissue. The vertebrae also have a strong bony "body" in front of the spinal cord to provide a platform suitable for weight-bearing.

The discs are pads that serve as "cushions" between the vertebral bodies that serve to minimize the impact of movement on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus). Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.

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What is a herniated disc? What causes a herniated disc?

As described above, each disc of the spine is designed much like a jelly donut. As the disc degenerates from age or injury, the softer central portion can rupture (herniate) through the surrounding outer ring (annulus fibrosus). This abnormal rupture of the central portion of the disc is referred to as a disc herniation. This is commonly referred to as a "slipped disc."

The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumber vertebrae in the low back. This area is constantly absorbing the impact of bearing the weight of the upper body. This is especially important when we are standing or sitting. The lower back is also critically involved in our body's movements throughout the day, as we twist the torso in rotating side to side and as we hinge the back in flexion and extension while bending or lifting.

Picture of herniated disc between L4 and L5

Picture of herniated disc between L4 and L5

Cross-section picture of herniated disc between L4 and L5

Cross-section picture of herniated disc between L4 and L5

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What are risk factors for a herniated disc?

Risk factors for a herniated disc include degeneration of the spine and heavy lifting or bending of the spine.

What are symptoms of a herniated disc?

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The symptoms of a herniated disc depend on the exact level of the spine where the disc herniation occurs and whether or not nerve tissue is being irritated. A disc herniation may not cause any symptoms. However, disc herniation can cause local pain at the level of the spine affected.

If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation. This can cause shooting pain in the distribution of that nerve and usually occurs on one side of the body and is referred to as sciatica. For example, a disc herniation at the level between the fourth and fifth lumbar vertebrae of the low back can cause a shooting pain down the buttock into the back of the thigh and down the leg. Sometimes this is associated with numbness, weakness, and tingling in the leg. The pain often is worsened upon standing and decreases with lying down. This is often referred to as a "pinched nerve."

If the disc herniation occurs in the cervical spine, the pain may shoot down one arm and cause a stiff neck or muscle spasm in the neck.

If the disc herniation is extremely large, it can press on spinal nerves on both sides of the body. This can result in severe pain down one or both lower extremities. There can be marked muscle weakness of the lower extremities and even incontinence of bowel and bladder. This complication is medically referred to as cauda equina syndrome

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How do health care professionals diagnose a herniated disc?

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The doctor will suspect a herniated disc when symptoms described above are present. The neurologic examination can reveal abnormal reflexes. Often pain can be elicited when the straight leg is raised when lying or sitting. This is referred to as a "positive straight leg raising test." There can be abnormal sensation in the foot or leg.

A variety of blood tests are frequently done to determine if there are signs of inflammation or infection.

Plain film X-rays can indicate "wear and tear" (degeneration) of the spine. They do not, however, demonstrate the status of discs. In order to determine whether or not a disc is herniated, an MRI scan or CT scan is performed for diagnosis. Sometimes a CT myelogram is used to further define the structures affected by a herniated disc. A CT myelogram is a CT that is performed after contrast dye is injected into the spinal canal. This allows for better visualization of the discs in certain cases. An electromyogram (EMG) can be used to document precisely which nerves are being irritated by a disc herniation.

What is the treatment for a herniated disc?

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Occasionally, disc herniation is incidentally detected when a test such as an MRI is performed for other reasons. If no symptoms are present, no particular treatment is necessary.

Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medications, anti-inflammation medications, local injection of cortisone (epidural injections), and surgical operations. In any case, all people with a disc herniation should rest and avoid reinjuring the disc. Sometimes, even people with relatively severe pain early on can respond to conservative measures, including physical therapy with an exercise regimen, epidural cortisone injection, and/or oral cortisone medication (such as methylprednisolone or prednisone), without the need for surgical intervention.

There are now a variety of surgical approaches to treat disc herniation. Each type of operation is customized to the individual situation and depends a great deal on the condition of the spine around the disc affected. Surgical options include microdiscectomy using small surgical instruments and open surgical repair (either from a posterior or anterior approach). Urgent operation can be necessary when cauda equina syndrome is present (reviewed above).

Picture of stapled incision post-surgery

Picture of stapled incision after surgery

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What are home remedies for a herniated disc?

Home remedies for disc herniation can be very effective in relieving the pain. These include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), as well as the application of heat and ice. Alternating heat and ice is very effective for pain relief for many people. Activity modification is also important, which includes avoidance of activities that aggravate pain and may worsen the nerve impingement. Bed rest and complete inactivity are unnecessary; they hinder recovery and are not advised.

What exercises and stretches can be done for a herniated disc?

Exercising is not advised for new symptoms of a herniated disc. On the other hand, building and maintaining strength in the back muscles and abdominal muscles is very important to prevent and treat chronic back problems. Exercises such as walking, physical therapy, and yoga have been proven to be very beneficial for those with chronic back pain.

Simple stretching can be very beneficial for symptoms of a herniated disc. Stretching should be started slowly and carefully. Stretching generally involves stretching the back in a backward bending position, called extension.

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What kind of health care professionals treat herniated discs?

Many different health care providers treat herniated discs. Usually patients will see their primary care provider initially, who may be a general practitioner or specialist in internal medicine or family practice. Other physicians who frequently see patients with herniated discs include emergency-medicine physicians, pain-management specialists, orthopedists, neurosurgeons, rheumatologists, and neurologists.

What is the prognosis (outlook) for a herniated disc?

The outlook for herniated disc depends on the severity and accompanying symptoms. While it is often possible to have full recovery with conservative treatment measures, sometimes surgical intervention is necessary because of persistent symptoms.

Is it possible to prevent a herniated disc?

A herniated disc can only be prevented by avoiding injury to the spine.

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Herniated Disc Center

Medically Reviewed on 3/16/2018

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