Herniated nucleus pulposus (slipped disk)
Alternative names:
cervical radiculopathy; herniated intervertebral disk; lumbar radiculopathy; prolapsed intervertebral disk; radiculopathy; ruptured disk; slipped disk
Symptoms:
SYMPTOMS OF LUMBAR RADICULOPATHY: SYMPTOMS OF CERVICAL RADICULOPATHY: - neck pain, especially in the back and sides
- deep pain near or over the shoulder blades on the affected side
- pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
- pain made worse with coughing, straining, or laughing
- increased pain when bending the neck or turning head to the side
- spasm of the neck muscles
- pain worse at night
- tenderness of the muscles on the opposite side from the injury
Signs and tests:
PHYSICAL EXAMINATION:
A physical examination and history of pain may be sufficient to diagnose the disorder. A neurological examination will be performed to evaluate muscle reflexes, sensation, and muscle strength. Often examination of the spine will reveal a decrease in the spinal curvature in the affected area.
Straight-leg-raising test that reveals leg pain is diagnostic of lumbar radiculopathy.
A "foraminal compression test of Spurling" will be performed to diagnose cervical radiculopathy. This is performed by bending the head forward and to the sides while downward pressure is applied to the top of the head. Increased pain or numbness during this test is usually indicative of cervical radiculopathy.
DIAGNOSTIC TESTS: - A spine X-ray may be performed to rule out other causes of back or neck pain. However, it is not possible to diagnosis herniated disk by spinal x-ray alone.
- A spine MRI and/or spine CT will show spinal canal compression by the herniated disk .
- A myelogram may be performed to define the size and location of disk herniation.
- An EMG may be performed to determine the exact nerve root(s) that is involved.
- A nerve conduction velocity test may also be performed.
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