A doctor will do a neurological exam to check for any changes in reflexes, muscle strength or sensation. Locating the origin of the pain may be enough to identify the herniated disk.

A spinal X-ray may eliminate other potential causes. However, X-rays do not show soft tissues very clearly. It may be necessary for the doctor to order magnetic resonance imaging (MRI), or computed tomography (CT) scans. Another helpful medical test is myelography — a radiological technique for viewing the spinal cord. This may be used to identify and determine the extent of a herniated disk. Sometimes doctors also do an electromyography (EMG) which is a nerve conduction test that may help determine the exact nerves involved.

What Are the Treatments?

Treatment calls for pain relief, rest, steps to reduce inflammation, and measures to restore strength and normal activity. Severe cases of disk degeneration may permanently affect the nerves that control muscle movement, but herniated disks generally heal themselves and surgery is rarely necessary.

If the disk is just temporarily distorted, the potential for complete recovery is excellent. If the outer membrane actually breaks or ruptures and loses some of its gelatinous center, the damage may be permanent.

Doctors usually prescribe bed rest of up to two days and pain-killing medication such as aspirin, ibuprofen, or another nonsteroidal anti-inflammatory drugs (NSAIDs). In some cases, corticosteroids (given either as a pill or injection around the spinal nerves) and/or muscle relaxants may be needed. People with backaches should remain active, being careful not to perform movements that cause pain or discomfort. Prolonged bed rest is a bad idea and may actually delay healing. A doctor may call for a back brace or neck collar to limit movement and ease the pressure on sensitive nerves while the disk heals. In severe cases, full or partial traction may be needed.

One non-surgical treatment option is transcutaneous electrical nerve stimulation (TENS). A TENS device applies a small electrical current to critical points along the path of a nerve. It doesn't hurt. Nobody is quite sure why it works.

Another nonsurgical treatment option is acupuncture. It's not clear how acupuncture works, either, but some patients get significant relief.

When the herniated disk causes weakness or paralysis of the nerves that control muscles of the back and limbs, or if one loses control of bladder or bowel function, the doctor may recommend surgery. Sometimes the surgeon will use a hollow needle to remove some of the soft core of a swollen disk so that it no longer impinges on a nerve. Other microsurgical procedures can remove fragments of core material that have broken through the fibrous outer wall. Diskectomy is the surgical removal of part of a herniated disk, and is done to relieve pressure on the nerve. In this procedure, the core of the disk is removed, leaving the tough outer casing in place between the vertebrae. Fusion can also be done for back instability. It sometimes brings long-term relief, but there is no guarantee of permanent recovery. Another surgical option is a procedure called a laminotomy in which a small amount of vertebral bone is removed to relieve pressure on the nerve.

Because any invasive therapy near the spinal cord is potentially dangerous, surgery should be undertaken only in extreme cases, when the herniated disk is causing weakness or paralysis of nerves going to muscles.

A controversial treatment, now largely out of favor, is chemonucleolysis, which is said to dissolve material in a herniated disk by an injection of the enzyme chymopapain. This isn’t used in the United States and is usually less effective than surgery.

Just as artificial replacements for damaged or worn parts are being surgically implanted in other parts of the body, intervertebral disk replacements were approved by the Food and Drug Administration in October 2004. The safety and long-term success of disk replacement remain to be seen, but like stainless-steel hip joints and plastic heart valves, synthetic versions of intervertebral disks may offer yet another medical option.

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