SLIPPED DISK - HERNIATED DISK:

GENERAL INFORMATION
SYMPTOMS

   Intravertebral disks are located
between the bones (vertebrae) of the
spine. The disks are composed of solid,
elastic tissue, held in place by
fibrous rings, and serve to absorb
shocks upon the spine. Weakening of a
ring may permit the disk to move out of
position (usually backward). The
resulting condition is called a
slipped, ruptured or herniated disk.
   Herniated disks occur most
frequently among active adults between
the ages of thirty and sixty, and are
most often located in the lumbar region
between the fifth lumbar vertebra and
sacrum, and between the fourth and
fifth or the third and fourth
vertebrae. The resulting pain in the
leg, caused by pressure upon the
sciatic nerve, is called sciatica.
Among the symptoms of herniation:

   1.  Pain in the lower back. Pain
       along the sciatic nerve
       (buttock, thigh and leg). The
       pain is generally unilateral,
       along one side of the hip and
       leg. There may be similar pain
       (crossover pain) upon bending or
       raising the opposite leg.
   2.  Increasing pain upon lifting,
       bending forward with the knees
       straight, or lifting the
       straight leg on the injured
       side.
   3.  In cases of severe herniation,
       possibly numbness and impaired
       sensation, loss of reflexes, or
       slight weakness of the foot
       and leg.
   4.  In cases of herniated disks of
       the neck: Severe neck pain, pain
       in the shoulder and arm, and
       numbness and weakness of one or
       both hands. This condition must
       be distinguished from spur
       formation on the cervical
       vertebrae (cervical spondylosis)
       and from so-called bursitis and
       arthritis of the shoulder joint.

CAUSES

   Natural erosion of supporting
tissues with the passage of years,
complicated by injury or strain, may
cause a disk to rupture its encircling
ring, usually protruding in a backward
direction since this is the direction
in which the fibrous rim is at its
weakest.

SPECIAL DANGERS AND PRECAUTIONS

   Back pain together with radiation of
pain down the leg may be caused by
conditions other than herniation of an
intravertebral disk. It should be
brought to the attention of a
physician.

TREATMENT

   The majority of patients with a
protruding disk recover without
treatment. Many recover after a
prolonged period of bed rest. Acute
pain may be treated with:
   1.  Aspirin, codeine or other
       analgesic drug.
   2.  Muscle relaxants.
   3.  Bed rest on a firm mattress.
   After the pain has lessened or
disappeared, the wearing of a back
brace may also be helpful. Traction may
be used, but probably does no more than
to restrict the patient's activity. If
it is successful, the patient remains
in traction for approximately 8-10
days.
   Full recovery may take as long as
several weeks to several months. And in
approximately 10-20 percent of severe
cases, the conservative treatment will
prove unsuccessful. Repeated acute
attacks of pain, unrelieved by measures
such as bed rest, stretch exercises or
muscle relaxant medication may then be
treated by surgical removal of the
herniated disk.
   There is generally little risk in
delaying surgery. Prompt surgery
becomes mandatory, however, in cases of
progressive weakness of the muscles of
the foot or ankle (dropped foot), as
well as in the extremely rare cases in
which signs appear of impairment of
bladder or sphincter control. At its
best, surgery will relieve the
sciatica. Such relief will occur in
80-90 percent of cases. In many cases
with predominantly lower back, buttock
and thigh pain, however, surgery is not
always successful.
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