Terminology Terms commonly used to describe the condition include herniated disc, prolapsed disc, ruptured disc, and slipped disc. Other conditions that are closely related include disc protrusion, radiculopathy (pinched nerve), sciatica, disc disease, disc degeneration, degenerative disc disease, and black disc (a totally degenerated spinal disc). The popular term slipped disc is a misnomer, as the intervertebral discs are tightly sandwiched between two vertebrae to which they are attached, and cannot actually "slip", or even get out of place. The disc is actually grown together with the adjacent vertebrae and can be squeezed, stretched and twisted, all in small degrees. It can also be torn, ripped, herniated, and degenerated, but it cannot "slip". Some authors consider that the term slipped disc is harmful, as it leads to an incorrect idea of what has occurred and thus of the likely outcome. However, during growth, one vertebral body can slip relative to an adjacent vertebral body, a deformity called spondylolisthesis.<unk>  is known in Latin as prolapsus disci intervertebralis. ; Click images to see larger versions File:Lumbar Disc Lesions Classification.Lumbar disc lesions, classification File:ACDF coronal english.Normal situation and<unk>  in cervical vertebrae File:Herniated Disc.Illustration depicting herniated disc and spinal nerve compression File:Disc prolapse.Nucleus<unk> g through tear in annulus (with MRI) File:Disc<unk>  - Degeneration Prolapse Extrusion Sequestration -- Smart-Servier.Illustration showing disc degeneration, prolapse, extrusion and sequestration. Physical examination Diagnosis of<unk>  is made by a practitioner on the basis of a patient's history and symptoms, and by physical examination. During an evaluation, tests may be performed to confirm or rule out other possible causes with similar symptoms – spondylolisthesis, degeneration, tumors, metastases and space-occupying lesions, for instance – as well as to evaluate the efficacy of potential treatment options. Straight leg raise The straight leg raise is often used as a preliminary test for possible disc<unk>  in the lumbar region. A variation is to lift the leg while the patient is sitting. However, this reduces the sensitivity of the test. A Cochrane review published in 2010 found that individual diagnostic tests including the straight leg raising test, absence of tendon reflexes, or muscle weakness were not very accurate when conducted in isolation. Spinal imaging * Projectional radiography (X-ray imaging). Traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, but they are still used to confirm or exclude other possibilities such as tumors, infections, fractures, etc. In spite of their limitations, X-rays play a relatively inexpensive role in confirming the suspicion of the presence of a herniated disc. If a suspicion is thus strengthened, other methods may be used to provide final confirmation. File:L5S1 prolapsed intervertibral disc PID.Narrowed space between L5 and S1 vertebrae, indicating probable prolapsed intervertebral disc - a classic picture. * Computed tomographyscan is the most sensitive imaging modality to examine the bony structures of the spine. CT imaging allows for the evaluation of calcified herniated discs or any pathological process that may result in bone loss or destruction. It is deficient for the visualization of nerve roots, making it unsuitable in the diagnoses of radiculopathy. * Magnetic resonance imaging is the gold standard study for confirming a suspected LDH. With a diagnostic accuracy of 97%, it is the most sensitive study to visualize a herniated disc due to its significant ability in soft tissue visualization. MRI also has higher inter-observer reliability than other imaging modalities. It suggests disc<unk>  when it shows an increased T2-weighted signal at the posterior 10% of the disc. Degenerative disc diseases have shown a correlation with Modic type 1 changes. When evaluating for postoperative lumbar radiculopathies, the recommendation is that the MRI is performed with contrast unless otherwise contraindicated. MRI is more effective than CT in distinguishing inflammatory, malignant, or inflammatory etiologies of LDH. It is indicated relatively early in the course of evaluation ( File:C5-C6-herniation.MRI scan of cervical disc<unk>  between C5 and C6 vertebrae. File:C6-C7-disc-herniation-cevical-mri-scan.MRI scan of cervical disc<unk>  between C6 and C7 vertebrae File:L4-l5-disc-herniation.MRI scan of large<unk>  (on the right) of the disc between L4 and L5 vertebrae File:Severe<unk>  of L4-L5 disc.A rather severe<unk>  of the L4–L5 disc File:Herniated-Disc.Example of a herniated disc at L5–S1 in the lumbar spine * Myelography. An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces will reveal displacement of the contrast material. It can show the presence of structures that can cause pressure on the spinal cord or nerves, such as herniated discs, tumors, or bone spurs. Because myelography involves the injection of foreign substances, MRI scans are now preferred for most patients. Myelograms still provide excellent outlines of space-occupying lesions, especially when combined with CT scanning (CT myelography). CT myelography is the imaging modality of choice to visualize herniated discs in patients with contraindications for an MRI. However, due to its invasiveness, the assistance of a trained radiologist is required. Myelography is associated with risks like post-spinal headache, meningeal infection, and radiation exposure. Recent advances with a multidetector CT scan have made the diagnostic level of it nearly equal to the MRI. * The presence and severity of myelopathy can be evaluated by means of transcranial magnetic stimulation (TMS), a neurophysiological method that measures the time required for a neural impulse to cross the pyramidal tracts, starting from the cerebral cortex and ending at the anterior horn cells of the cervical, thoracic, or lumbar spinal cord. This measurement is called the central conduction time (CCT). TMS can aid physicians to: :*determine if myelopathy exists :*identify the level of the spinal cord where myelopathy is located. This is especially useful in cases where more than two lesions may be responsible for the clinical symptoms and signs, such as in patients with two or more cervical disc hernias :*assess the progression of myelopathy with time, for example before and after cervical spine surgery :*TMS can also help in the differential diagnosis of different causes of pyramidal tract damage. * Electromyography and nerve conduction studies (EMG/NCS) measure the electrical impulses along nerve roots, peripheral nerves, and muscle tissue. Tests can indicate if there is ongoing nerve damage, if the nerves are in a state of healing from a past injury, or if there is another site of nerve compression. EMG/NCS studies are typically used to pinpoint the sources of nerve dysfunction distal to the spine. Differential diagnosis Tests may be required to distinguish<unk> s from other conditions with similar symptoms. * Discogenic pain * Mechanical pain * Myofascial pain * Abscess * Aortic dissection * Discitis or osteomyelitis * Hematoma * Mass lesion or malignancy * Binign tumor like neurinoma or meningeoma * Myocardial infarction * Sacroiliac joint dysfunction * Spinal stenosis * Spondylosis or spondylolisthesis
Spinal disc herniation
Piriformis syndrome
Spinal tumor
Lumbar disc disease
Spinal stenosis
Degenerative disc disease
Lumbar spinal stenosis
Cervical spinal stenosis