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     Disc herniations, also called disc prolapse, herniated nucleus
pulposis (HNP), ruptured discs, or "slipped discs" are a common
source of back pain and pain traveling in a band down the leg into the
foot (if from a lumbar HNP) or neck pain and pain traveling into the
arm and hand (if from a cervical HNP). They occur most often in the
lumbar spine at L4-5 and L5-S1 and in the cervical spine at C5-6. It is
rare for these to occur in the thoracic spine (1% of all disc herniations)
with any degree of clinical significance.
    A disc herniation is a focal bulging of the innermost part of the disc
(nucleus pulposis) through the outer wall of the disc (annulus fibrosis).
Such disc herniations may compress nerves resulting in numbness, can
compress the spinal canal resulting in symptoms of spinal stenosis, can
compress the spinal cord itself in the thoracic, cervical, or lower lumbar
spine causing symptoms of myelopathy (loss of bowel or bladder
control, weakness in the arms or legs, falling down, etc), or can cause
compression of the ligaments such as the posterior longitudinal
ligament resulting in back pain. If the protrusion is not significant
enough to cause compression of these structures, the disc herniation
can still cause pain due to the enzymes and chemicals spilling from the
disc onto ligaments, nerves, etc.
     There are many treatments for disc herniations. Conservative
measures include PT, traction, home inversion tables, VAX-D,
chiropractic, very limited bed rest, non-narcotic and narcotic
analgesics, muscle relaxants, avoidance of heavy lifting or bending
forward at the waist. Minimally invasive treatments include
transforaminal epidural steroid injections or intradiscal decompression
techniques (LASE, coblation nucleoplasty, dekompressor, APLD, etc).
More aggressive minimally invasive techniques include selective
endoscopic discectomy. Open surgery includes METRX system tubular
surgery, microdiscectomy, laminectomy/discectomy, and artificial disc
replacement. Experimental techniques include tumor necrosis factor
inhibitors and intradiscal ozone therapy. Most disc herniations do not
require surgery, but if the symptoms continue to persist beyond 2-3
months, permanent scar tissue may result around the nerve root if the
herniation is not addressed. If there is loss of bowel or bladder control
or severe weakness (not just pain) in the arms or legs, etc, evaluation
by your physician should commence immediately.