Slipped Disk? What does that Mean?

What is a Slipped Disk?

Slipped Disk is a common term that no one seems to know exactly what it means,  where it came from, or how it originated. The truth is intervertebral discs do not slip. 

Similar to someone saying, “My back went out on me". Well, "Where did your back go? If it went out it must have went somewhere. Where did it go?"  

What does that Mean?

I think what they really mean is that they injured their back, or they are having a flare-up of back pain. 

  

  

But you cannot have a "slipped disk"

Your spine is formed by 24 bones or vertebrae stacked on top of each other.
Each vertebra is connected to the next by intervertebral discs. 

The Anatomy of Your Intervertebral Disc

These discs each have 2 parts:

The Annulus

The annulus is a flexible, tough, ligament-like material that wraps around the outside of each disc and actually connects one vertebra to the next.

The Nucleus Pulposis

The nucleus is a soft jelly kind of material that is contained inside of the disc.

Together these 2 parts of the disc act as a shock absorber between each pair of vertebrae. They allow a small amount of motion at each level of your spine. This allows us to bend and twist the way that we do. 

A Bulging Disc

A bulging disc occurs when the annulus starts to weaken. It will stretch and bulge out away from the center of the disc. 

This usually develops slowly with age and poor posture. It may advance faster with heavy work or aggressive physical sports such as football or martial arts. 

Develops Gradually

The pain of a bulging disc will increase gradually and may be described as an ache rather than sharp and stabbing. 

If the bulging portion of the disc is pressing on a nerve it may also cause pain radiating into your buttock and the back of your thigh. 

A Ruptured or Herniated Disc

A herniated disc can occur when a tear or a break in the annulus develops allowing some of the nucleus to escape from the disc. 

This may happen suddenly with trauma from an accident or fall. A herniation may also occur when months or years of vigorous sports such as rugby or gymnastics cause degeneration of the annulus. 

Back Pain and Possibly Leg Pain

A ruptured disc will usually cause back pain that starts suddenly, most commonly in your lumbar spine, and the pain may be very severe. 

When the extruded piece of disc is pressing on a nerve there can also be pain and/or weakness radiating into your buttock and the back of your thigh.

Annular Tear or Fissure 

As we age our discs lose moisture and become less flexible. When the annulus becomes stiff and dry it may develop a crack or fissure with just normal activity such as bending to tie your shoe. 

Back Pain and not Leg Pain

When the annulus becomes so stiff and dried out that it cracks the nucleus is often also dried out. This desiccated or dried out disc presents little risk of herniation which may press on a nerve causing pain into your lower extremities. 

However, the annulus is full of nerve endings and a crack or fissure can cause severe back pain. Because the intervertebral discs have such poor blood supply such injuries are very slow to heal or they may never heal at all.   

Treatments for your Disc

Treatment Decisions based on Imaging Studies and the Severity of Your Symptoms

Your doctor can make decisions on which treatment is correct for you based on the size of the rupture that he sees on your MRI or CT scan and the severity of your symptoms.

Bulging Disc Treatments

Bulging discs are not usually treated with surgery. They are most commonly managed with physical therapy exercises and anti-inflammatory medications. 

Steroid injections are also an option for disc bulges that are causing pain. However, the pain does tend to recur and the injections often need to be repeated. 

Annular Fissures or Cracks

Steroid injections may be helpful for this type of injury but the results are variable depending on the exact location of the fissure. 

Your doctor may need to treat you with anti-inflammatory medications. If these are not adequate, and the pain is severe, he may prescribe stronger narcotic medications. 

Herniated Disc

A herniated disc may be treated with surgery to remove the piece of disc or conservatively with limited activity, anti-inflammatory drugs, and pain medication.

Another option for treatment would be steroid injections. Injecting steroid medication into the area of the disc herniation will reduce swelling and inflammation, and hopefully relieve pain. 

Surgical Treatment Outcomes

Studies show that disc herniations treated with surgery and those treated conservatively are all about the same after 5 years. 

The difference is that people treated with surgery get better and return to full activity faster than people treated conservatively. But, surgery has risks that your doctor must consider and it is never an easy decision.