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The vertebrae (bones of the spine) are cushioned by blocks or pads of tissue called disks. These disks are round and flat and made up of 2 parts: the annulus (a tough outer capsule or ring) and the nucleus (an inner, spongy core of jellylike material). When these disks are healthy, they act as shock absorbers for the spine and are essential in keeping the spine flexible. The normal, everyday pressures on the spine force the outer surface to bulge slightly. When these disks are damaged from an injury, normal wear and tear, or disease, they may bulge abnormally or rupture (break open). When a damaged disk bulges abnormally or ruptures, it is called a herniated (slipped) disk. Herniated disks can occur in any part of the spine but most often affect the lumbar spine (lower back). The abnormal disk material can place pressure on the adjacent spinal cord or nerve roots, resulting in pain, numbness, or weakness in areas of the lower back, buttocks, and legs. The November 22/29, 2006, issue of JAMA includes 2 articles about surgery for herniated disks.
Natural aging process—ongoing loss of water and proteins from the disk
Genetic (inherited) predisposition—an accelerated degeneration of disk materials
Obesity—excessive body weight places added stress on the spine
Lack of exercise—results in a loss of trunk muscle strength and diminished spine support
Work activities—long periods of sitting, lifting or pulling heavy objects, frequent bending or twisting, heavy physical exertion, repetitive motions, or exposure to constant vibration
Smoking—deprives blood flow and nutrients needed for disk repairs
History of back injury, previous herniated disk, or prior back surgery
A moderate injury causes immediate numbness or weakness in one or both legs
You have shooting leg pains with coughing, sneezing, or straining
Leg pain is accompanied by persistent weakness, tingling, or numbness
Back pain persists or builds in intensity over a few weeks' duration
Back pain is accompanied by pain during urination
You experience severe deep back muscle pain and muscle spasms
You have loss of bowel or bladder control
Diagnosis is based on a complete medical history accompanied by a thorough physical examination performed by your doctor. Tests involving imaging of the spine are sometimes done. Treatments can include oral medications, drug injections, and physical therapy. Most back and leg pain will resolve with these simple measures. For persons who have chronic pain and disability, surgical options may be considered.
American Academy of Family Physicianshttp://familydoctor.org/341.xml
American Association of Orthopaedic Surgeonshttp://www.aaos.org
American Association of Neurological Surgeonshttp://www.neurosurgerytoday.org/what/patient_e/herniated.asp
To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish.
Sources: American Academy of Family Physicians, American Association of Orthopaedic Surgeons, American Association of Neurological Surgeons
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724.
TOPIC: BACK PAIN
Zeller JL, Burke AE, Glass RM. Herniated Lumbar Disks. JAMA. 2006;296(20):2512. doi:10.1001/jama.296.20.2512