Herniated nucleus pulposus (slipped disk)

A h e r n i a t e d n u c l e u s p u l p o s u s i s a s l i p p e d d i s k a l o n g t h e s p i n a l c o r d . T h e condi tion occurs when all or part of the soft center of a spinal disk is forced through a weakened part of the disk. Alternative Names Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; lipped disk; !uptured disk; Herniated nucleus pulposus

Causes, incidence, and risk factors The bones "vertebrae# of the spinal column run down the back$ connecting the skull to the pelvis. These bones protect nerves that come out of the brain and travel down your back$ forming the spinal cord. %erve

roots are large nerves that branch out from the spinal cord and leave your spinal column between each vertebrae. The spinal vertebrae are separated by disks filled with a soft$ gelatinous substance. These disks cushion the spinal column and space between your vertebrae. These disks may herniate "move out of place# or rupture from trauma or strain. &hen this happens$ the spinal nerves may become compressed$ resulting in pain$ numbness$ or weakness. The lower back "lumbar area# of the spine is the most common area for a slipped disk. The cervical "neck# disks are affected '( of the time. The upper)to)mid)back "thoracic# disks are rarely involved.

!adiculopathy refers to any disease that affects the spinal nerve roots. A herniated disk is one cause of radiculopathy "sciatica#. *isk herniation occurs more fre+uently in middle)aged and older men$ especially those involved in strenuous physical activity. ,ther risk factor include any conditions present at birth "congenital# that affect the si-e of the lumbar spinal canal. Stages of Herniated nucleus pulposus

.. Disc Degeneration: chemical changes associated with aging cause discs to become dehydrated$ collapsed and weak$ but without a frank herniation. These changes can be observed on /!0 scans$ and are fre+uently asymptomatic.

1. Disc Prolapse: the disc bulges and may cause slight narrowing of the spinal canal. This is also known as a disc bulge or protrusion. 2. E trusion: the soft$ gel)like nucleus pulposus ruptures through the annulus fibrosus but remains within the disc. 3. Disc Se!uestration (Se!uestered Disc): this occurs when the central$ gelatinous portion of the disc "nucleus pulposus# is s+uee-ed out and is also separated from the main part of the disc. The nucleus pulposus breaks therefore lies outside the disc and within the spinal canal.
S"mptoms Low back or neck pain can vary widely. 0t may feel like a mild tingling$ dull ache$ or a burning or pulsating sensation. 0n some cases$ the pain is severe enough that you are unable to move. 4ou may also have numbness. The pain most often occurs on one side of the body. &ith a lumbar "lower back# herniated disk$ you may have sharp pain in one part of the leg$ hip$ or buttocks and numbness in other parts. 4ou may also feel the sensations on the back of the calf or sole of the foot. The affected leg may feel weak. &ith a cervical "neck# disk herniation$ you may have pain when moving your neck$ deep pain near or over the shoulder blade$ or pain that radiates to the upper arm$ forearm$ or "rarely# fingers.

The pain often starts slowly. 0t may get worse5 After standing or sitting At night &hen snee-ing$ coughing$ or laughing &hen bending backwards or walking more than a few yards$ especially if it is caused by spinal stenosis

4ou may also have weakness in certain muscles. ometimes$ you may not notice it until your doctor e6amines you. 0n other cases$ you will notice that you have a hard time lifting your leg or arm$ standing on your toes on one side$ s+uee-ing tightly with one of your hands$ or other problems. The pain$ numbness$ or weakness often will go away or improve a lot over a period of weeks to months.

Pathophysiology How the disc works

Imagine that you have blown up a small red balloon and sandwiched it between two slices of bread. When you squeeze the slices of bread together, the balloon resists the squeeze and expands out of the side of the sandwich. our disc wor!s in exactly the same way, only that the discs wall is much thic!er and has a "elly center

instead of air. #ow, instead of squeezing the balloon down evenly on both side, squeeze down the sandwich at "ust one end. $he balloon should expand out at the other end of the sandwich. If this position is held for long time, the balloon will becoming permanently stretched at one end. When you let go of the sandwich, the balloon end will not shrin! bac! fully but will remainly slightly loose. $he more often you stretch it and the longer you hold the stretch, the looser is gets over time. $he "elly center bounces bac! but the tougher surrouding fibres wont. If they are over%stretched, they either brea! or remaining stretched.

Pathophysiology[edit]
There is now recognition of the importance of 7chemical radiculitis8 in the generation of back pain.9.2: A primary focus of surgery is to remove 7pressure8 or reduce mechanical compression on a neural element5 either the spinal cord$ or a nerve root. ;ut it is increasingly recogni-ed that back pain$ rather than being solely due to compression$ may also be due to chemical inflammation.9.2:9.3:9.<:9.=: There is evidence that points to a specific inflammatory mediator of this pain.9.>:9.': This inflammatory molecule$ called tumor necrosis factor)alpha "T%?#$ is released not only by the herniated disc$ but also in cases of disc tear "annular tear#$ by facet @oints$ and in spinal stenosis.9.2:9.A:91B:91.: 0n addition to causing pain and inflammation$ T%? may also contribute to disc degeneration.911: