Spinal disc herniation - Knowledge (XXG)

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suggests disc herniation 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 (<8 weeks) when the patient presents with relative indications like significant pain, neurological motor deficits, and cauda equina syndrome. Diffusion tensor imaging is a type of MRI sequence used for detecting microstructural changes in the nerve root. It may be beneficial in understanding the changes that occur after herniated lumbar disc compresses a nerve root, and might help in differentiating the patients that need surgical intervention. In patients with a high suspicion of radiculopathy due to lumbar disc herniation, yet the MRI is equivocal or negative, nerve conduction studies are indicated.

706: 1133:. Moderate quality evidence suggests that spinal manipulation is more effective than placebo for the treatment of acute (less than 3 months duration) lumbar disc herniation and acute sciatica. The same study also found "low to very low" evidence for its usefulness in treating chronic lumbar symptoms (more than 3 months) and "the quality of evidence for ... cervical spine-related extremity symptoms of any duration is low or very low". A 2006 review of published research states that spinal manipulation "is likely to be safe when used by appropriately-trained practitioners", and research currently suggests that spinal manipulation is safe for the treatment of disc-related pain. 874:. 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. 774: 820: 513: 651: 844: 832: 460: 663: 1223:

disc appears to provide faster relief from the acute attack than non‐surgical management. However, any positive or negative effects on the lifetime natural history of the underlying disc disease are unclear. Microdiscectomy gives broadly comparable results to standard discectomy. There is insufficient evidence on other surgical techniques to draw firm conclusions." Regarding the role of surgery for failed medical therapy in people without a significant neurological deficit, a

766:(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. 808: 675: 856: 1373: 690: 69: 314:) on the posterior side (back side) of the disc. The combination of membrane-thinning from stretching and increased internal pressure (14 to 21 bar (200 to 300 psi)) can result in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, which may produce intense and potentially disabling pain and other symptoms. 1068:(FDA) suggested that the "injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death", and that "the effectiveness and safety of epidural administration of corticosteroids have not been established, and FDA has not approved corticosteroids for this use". 454:

postero-lateral herniation of the disc between vertebrae C5 and C6 will impinge on the right C6 spinal nerve. The rest of the spinal cord, however, is oriented differently, so a symptomatic postero-lateral herniation between two vertebrae will impinge on the nerve exiting at the next intervertebral level down.

870:. 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 503:

can also be affected and cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet or a burning feeling in the hips and legs. A herniation in the lumbar region often compresses the nerve root exiting at the level below the disc. Thus, a herniation of the L4–5

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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

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is relatively thin and is not reinforced by the posterior or anterior longitudinal ligament. In the cervical spine, a symptomatic postero-lateral herniation between two vertebrae will impinge on the nerve which exits the spinal canal between those two vertebrae on that side. So, for example, a right

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is a set of symptoms associated with disc herniation. A study on sciatica showed that about one-third of patients with sciatica recover within two weeks after presentation using conservative measures alone, and about three-quarters of patients recovered after three months of conservative treatment.

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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.

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When different forms of surgical treatments including (discetomy, microdiscectomy, and chemonucleolysis) were compared evidence was suggestive rather than conclusive. A Cochrane review from 2007 reported: "surgical discectomy for carefully selected patients with sciatica due to a prolapsed lumbar

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are still intact, but can bulge when the disc is under pressure. In contrast to a herniation, none of the central portion escapes beyond the outer layers. Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or

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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

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Following surgery, rehabilitation programs are often implemented. There is wide variation in what these programs entail. A Cochrane review found low- to very low-quality evidence that patients who participated in high-intensity exercise programs had slightly less short term pain and disability

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Cervical disc herniations occur in the neck, most often between the fifth and sixth (C5–6) and the sixth and seventh (C6–7) cervical vertebral bodies. There is an increased susceptibility amongst older (60+) patients to herniations higher in the neck, especially at C3–4. Symptoms of cervical

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Non-surgical methods of treatment are usually attempted first. Pain medications may be prescribed to alleviate acute pain and allow the patient to begin exercising and stretching. There are a number of non-surgical methods used in attempts to relieve the condition. They are considered

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Rabin A, Gerszten PC, Karausky P, Bunker CH, Potter DM, Welch WC (2007). "The sensitivity of the seated straight-leg raise test compared with the supine straight-leg raise test in patients presenting with magnetic resonance imaging evidence of lumbar nerve root compression".

306:) (lying down) to over 21 bar (300 psi) (lifting with a rounded back). Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents ( 1344:

bracing, and floor bridges. If pain is present in the back, it can mean that the stabilization muscles of the back are weak and a person needs to train the trunk musculature. Other preventative measures are to lose weight and not to work oneself past fatigue. Signs of

1247:. Lumbar disc herniation occurs 15 times more often than cervical (neck) disc herniation, and it is one of the most common causes of low back pain. The cervical discs are affected 8% of the time and the upper-to-mid-back (thoracic) discs only 1–2% of the time. 2624:

Igarashi T, Kikuchi S, Shubayev V, Myers RR (Dec 2000). "2000 Volvo Award winner in basic science studies: Exogenous tumor necrosis factor-alpha mimics nucleus pulposus-induced neuropathology. Molecular, histologic, and behavioral comparisons in rats".

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found shortcomings in most published studies and concluded that there was only "very limited evidence in the scientific literature to support the effectiveness of non-surgical spinal decompression therapy". Its use and marketing have been very

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Anjankar SD, Poornima S, Raju S, Jaleel M, Bhiladvala D, Hasan Q. Degenerated intervertebral disc prolapse and its association of collagen I alpha 1 Spl gene polymorphism: A preliminary case control study of Indian population. Indian J Orthop

936:(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 4092: 4077: 223:

that radiates into regions served by nerve roots which have been irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as patients present with undefined pains in the thighs, knees, or feet.

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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

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provide a slight and questionable short-term improvement for those with sciatica, but are of no long-term benefit. Complications occur in up to 17% of cases when injections are performed on the neck, though most are minor. In 2014, the

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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.

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Pinto, RZ; Maher, CG; Ferreira, ML; Hancock, M; Oliveira, VC; McLachlan, AJ; Koes, B; Ferreira, PH (18 December 2012). "Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis".

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Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue involved. They can range from little or no pain, if the disc is the only tissue injured, to severe and unrelenting

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Moore, Keith L. Moore, Anne M.R. Agur; in collaboration with and with content provided by Arthur F. Dalley II; with the expertise of medical illustrator Valerie Oxorn and the developmental assistance of Marion E. (2007).

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van der Windt, Daniëlle AWM; Simons, Emmanuel; Riphagen, Ingrid I; Ammendolia, Carlo; Verhagen, Arianne P; Laslett, Mark; Devillé, Walter; Deyo, Rick A; Bouter, Lex M; de Vet, Henrica CW; Aertgeerts, Bert (2010-02-17).

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Disc herniations can result from general wear and tear, such as weightlifting training, constant sitting or squatting, driving, or a sedentary lifestyle. Herniations can also result from the lifting of heavy loads.

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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

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When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 1.2

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Intradural disc herniation is a rare form of disc herniation with an incidence of 0.2–2.2%. Pre-operative imaging can be helpful for diagnosis, but intra-operative findings are required for confirmation.

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of the spinal cord or nerve roots, but may also be caused by chemical inflammation. There is evidence that points to a specific inflammatory mediator in back pain: an inflammatory molecule, called

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with a one-inch skin opening has not been shown to result in a significantly different outcome from larger-opening discectomy with respect to pain. It might however have less risk of infection.

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disc protrusions in 50% of participants, suggesting that a considerable part of the population might have focal herniated discs in their cervical region that do not cause noticeable symptoms.

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Earhart, Jeffrey S.; Roberts, David; Roc, Gilbert; Gryzlo, Stephen; Hsu, Wellington (January 2012). "Effects of Lumbar Disk Herniation on the Careers of Professional Baseball Players".

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Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ (Sep 2005). "Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers".

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Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation. The former is the most common, causing

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When a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings, the disc is said to be herniated.

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Kraemer J (March 1995). "Natural course and prognosis of intervertebral disc diseases. International Society for the Study of the Lumbar Spine Seattle, Washington, June 1994".

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A herniated disc in the lumbar spine may cause radiating nerve pain in the lower extremities or groin area and may sometimes be associated with bowel or bladder incontinence.

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is often used as a preliminary test for possible disc herniation in the lumbar region. A variation is to lift the leg while the patient is sitting. However, this reduces the

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Some authors favour degeneration of the intervertebral disc as the major cause of spinal disc herniation and cite trauma as a minor cause. Disc degeneration occurs both in

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Typically, symptoms are experienced only on one side of the body, but if a herniation is very large and presses on the nerves on both sides within the spinal column or the

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Surgery may be useful when a herniated disc is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control.

1218:(in which there is incontinence, weakness, and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression. 1353:, poor coordination, muscle burning, and loss of the transverse abdominal brace. Heavy lifting should be done with the legs performing the work, and not the back. 1600: 3300:

Abbasi A, Malhotra G, Malanga G, Elovic EP, Kahn S (Sep 2007). "Complications of interlaminar cervical epidural steroid injections: a review of the literature".

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McCarron RF, Wimpee MW, Hudkins PG, Laros GS (Oct 1987). "The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain".

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Foreman, A. Croft, S. Whiplash Injuries The Cervical Acceleration/Deceleration Syndrome. Williams and Wilkins. 428 E. Preston Street. Baltimore, MD. 21202 p 469

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Sekiguchi M, Kikuchi S, Myers RR (May 2004). "Experimental spinal stenosis: relationship between degree of cauda equina compression, neuropathology, and pain".

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Séguin CA, Pilliar RM, Roughley PJ, Kandel RA (Sep 2005). "Tumor necrosis factor-alpha modulates matrix production and catabolism in nucleus pulposus tissue".

1884:"Incidence rates and characteristics of abnormal lumbar findings and low back pain in child and adolescent weightlifter: A prospective three-year cohort study" 2695:

Igarashi A, Kikuchi S, Konno S, Olmarker K (Oct 2004). "Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders".

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is a significant, potentially disabling, result that can arise following invasive spine surgery to treat disc herniation. Smaller spine procedures such as

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Al-Ryalat, Nosaiba Tawfik; Saleh, Saif Aldeen; Mahafza, Walid Sulaiman; Samara, Osama Ahmad; Ryalat, Abdee Tawfiq; Al-Hadidy, Azmy Mohammad (March 2017).

1057:(NSAIDs), but long-term use of NSAIDs for people with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity. 429:. Within athletic contexts, herniation is often the result of sudden blunt impacts against, or abrupt bending or torsional movements of, the lower back. 3172:

Chen R, Cros D, Curra A, et al. (March 2008). "The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee".

843: 807: 1579: 725:. During an evaluation, tests may be performed to confirm or rule out other possible causes with similar symptoms – spondylolisthesis, degeneration, 674: 383:– that encode for proteins and enzymes involved in the regulation of the extracellular matrix has been shown to contribute to lumbar disc herniation. 329:– become exposed to altered loads. Specifically, the nucleus becomes fibrous and stiff and less able to bear load. Excess load is transferred to the 4210: 282:

can cause permanent nerve damage or paralysis which can result in loss of bowel and bladder control and sexual dysfunction. This disorder is called

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The following locations have no discs and are therefore exempt from the risk of disc herniation: the upper two cervical intervertebral spaces, the

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Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T (Jan 1996). "Inflammatory cytokines in the herniated disc of the lumbar spine".

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In the majority of cases spinal disc herniation can be treated successfully conservatively, without surgical removal of the herniated material.

4480: 1627: 3783: 2268: 1565: 855: 413:, are known to be prone to disc herniations as well as some limited contact sports that require repetitive flexion and compression such as 3856:

Oosterhuis, Teddy; Costa, Leonardo OP; Maher, Christopher G; de Vet, Henrica CW; van Tulder, Maurits W; Ostelo, Raymond WJG (2014-03-14).

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Oliphant, D (2004). "Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations: A Systematic Review and Risk Assessment".

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Lumbar disc herniations occur in the back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the

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Del Grande F, Maus TP, Carrino JA (July 2012). "Imaging the intervertebral disk: age-related changes, herniations, and radicular pain".

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Nordhoff, L. Motor Vehicle Collision Injuries, Mechanisms, Diagnosis and Management. Aspen Publisher, Inc. Gaithersburg, MD 1996 p 94

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material doesn't press on soft tissues or nerves. A small-sample study examining the cervical spine in symptom-free volunteers found

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WHO guidelines on basic training and safety in chiropractic. "2.1 Absolute contraindications to spinal manipulative therapy", p. 21.

2926: 1717: 882: 3466: 3589:"Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?" 2063: 2042: 3367:

Leininger B, Bronfort G, Evans R, Reiter T (2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review".

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Kobayashi, K (October 2014). "Intradural disc herniation: Radiographic findings and surgical results with a literature review".

1835:"A Functional Polymorphism in THBS2 that Affects Alternative Splicing and MMP Binding Is Associated with Lumbar-Disc Herniation" 2946: 1320:

Education should emphasize not lifting beyond one's capabilities and giving the body a rest after strenuous effort. Over time,

1065: 166: 203:, but this term is not accurate as the spinal discs are firmly attached between the vertebrae and cannot "slip" out of place. 4475: 1495: 170: 31: 1143:

Spinal manipulation is contraindicated when the etiology of the herniation is the result of a Motor Vehicle Collision (MVC)

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Haldeman, S. Principles and Practice of Chiropractic. Appleton & Lange, 25 Van Zant Str., East Norwalk, CT. 1992 p 565

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Ahn, Yong; Choi, Gun; Lee, Sang-Ho (2016). "History of Lumbar Endoscopic Spinal Surgery and the Intradiskal Therapies".

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Diagnosis of spinal disc herniation is made by a practitioner on the basis of a patient's history and symptoms, and by

2317:"Myelopathy associated with age-related cervical disc herniation: a retrospective review of magnetic resonance images" 2230: 1978: 1296:

Because there are various causes of back injuries, prevention must be comprehensive. Back injuries are predominant in

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Mutations in several genes have been implicated in intervertebral disc degeneration. Probable candidate genes include

3461: 1177:(the partial removal of a disc that is causing leg pain) can provide pain relief sooner than non-surgical treatments. 2740:"Up-regulation of p55 TNF alpha-receptor in dorsal root ganglia neurons following lumbar facet joint injury in rats" 1231:

compared to low-intensity exercise programs. There was no difference between supervised and home exercise programs.

1426: 1360:. The usage of lumbar-sacral support belts may restrict movement at the spine and support the back during lifting. 1060: 937: 792: 681: 623:

It can also be torn, ripped, herniated, and degenerated, but it cannot "slip". Some authors consider that the term

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Narrowed space between L5 and S1 vertebrae, indicating probable prolapsed intervertebral disc – a classic picture

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Deftereos SN, et al. (April–June 2009). "Localisation of cervical spinal cord compression by TMS and MRI".

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disc tear are generally effective. Severe herniations may not heal of their own accord and may require surgery.

4122: 763: 122: 4268: 4012:"Regeneration of intervertebral disc by mesenchymal stem cells: potentials, limitations, and future direction" 3711:"Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation" 3344:"Epidural Corticosteroid Injection: Drug Safety Communication - Risk of Rare But Serious Neurologic Problems" 449:

region accounts for only 1–2% of cases. Herniations usually occur postero-laterally, at the points where the

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Hsu, Wellington K. (August 2010). "Lumbar and Cervical Disk Herniations in NFL Players: Return to Action".

1086: 141:, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by 4307: 1109: 1105: 954: 933: 263: 2211:"[The incidence of disk changes in volleyball players. The magnetic resonance findings] - PubMed" 4454: 1471: 1212: 1078: 1015: 550:

It is increasingly recognized that back pain resulting from disc herniation is not always due solely to

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Disc herniation is frequently associated with age-related degeneration of the outer ring, known as the

3404:"Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review" 1149:

is contraindicated for disc herniations when there are progressive neurological deficits such as with

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However the study did not indicate the number of individuals with sciatica that had disc herniations.

3053:"Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain" 1895: 1341: 1201: 1188: 1157: 885:(TMS), a neurophysiological method that measures the time required for a neural impulse to cross the 722: 390: 1683: 1615: 459: 4431: 4096: 2971:

Waddell G, McCulloch JA, Kummel E, Venner RM (1980). "Nonorganic physical signs in low-back pain".

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assess the progression of myelopathy with time, for example before and after cervical spine surgery

894: 785: 161:, but is normally triggered by trauma or straining by lifting or twisting. Tears are almost always 110: 3748: 3431: 3325: 3282: 3197: 2996: 2855: 2812: 2720: 2650: 2606: 2563: 2485: 2439: 2278: 2090:"Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations" 1970: 1941:

Videman, T.; Sarna, S.; Battié, M. C.; Koskinen, S.; Gill, K.; Paananen, H.; Gibbons, L. (1995).

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Shimozaki, K.; Nakase, J.; Yoshioka, K.; Takata, Y.; Asai, K.; Kitaoka, K.; Tsuchiya, H. (2018).

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concluded that "limited evidence is now available to support some aspects of surgical practice".

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TMS can also help in the differential diagnosis of different causes of pyramidal tract damage.

800:-weighted images allow for clear visualization of protruded disc material in the spinal canal. 629: 398: 372: 278:, both sides of the body may be affected, often with serious consequences. Compression of the 76: 3462:"Spinal manipulation in patients with disc herniation: A critical review of risk and benefit" 3270: 2873: 4324: 4234: 4031: 4023: 3952: 3944: 3885: 3869: 3828: 3812: 3771: 3730: 3722: 3674: 3612: 3602: 3513: 3475: 3415: 3376: 3309: 3266: 3228: 3181: 3060: 3024: 2980: 2839: 2796: 2759: 2751: 2704: 2677: 2634: 2590: 2547: 2512: 2503:

Marshall LL, Trethewie ER (Aug 1973). "Chemical irritation of nerve-root in disc prolapse".

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to address mechanical factors, and may include modalities to temporarily relieve pain (i.e.

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It is possible to have a herniated disc without pain or noticeable symptoms if the extruded

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Bartolozzi, C.; Caramella, D.; Zampa, V.; Dal Pozzo, G.; Tinacci, E.; Balducci, F. (1991).

1308:. Prevention must come from multiple sources such as education, proper body mechanics, and 4399: 4367: 3650: 3646: 3572: 2930: 2898: 1476: 1278:

4.8% of males and 2.5% of females older than 35 experience sciatica during their lifetime.

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changes ("dries out") and the risk of herniation is greatly reduced. After age 50 or 60,

570:. In addition to causing pain and inflammation, TNF may contribute to disc degeneration. 3735: 3710: 1899: 1085:, relatively contraindicated, or inconclusive, depending on the safety profile of their 251:, pain from a herniated disc is usually continuous or at least continuous in a specific 4372: 4360: 4219: 4173: 4036: 4011: 3957: 3932: 3890: 3857: 3833: 3800: 3709:

Rasouli, MR; Rahimi-Movaghar, V; Shokraneh, F; Moradi-Lakeh, M; Chou, R (Sep 4, 2014).

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Sommer C, Schäfers M (2004). "Mechanisms of neuropathic pain: the role of cytokines".

2516: 1372: 4469: 4421: 4404: 4350: 4287: 2984: 2800: 2638: 2594: 2551: 2012: 1958: 1533: 1461: 1421: 1325: 1301: 1258:. Most disc herniations occur when a person is in their thirties or forties when the 1240: 989: 737:, for instance – as well as to evaluate the efficacy of potential treatment options. 604: 500: 492: 394: 369: 365: 244: 220: 58:

Slipped disc, bulging disc, ruptured disc, herniated disc, prolapsed disc, herniated

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3435: 3329: 3286: 3000: 2950: 2859: 2816: 2724: 2654: 2610: 2567: 2489: 2443: 68: 4314: 3873: 3816: 3726: 3201: 3064: 2427: 1974: 1560:. A. M. R. Agur, Arthur F., II Dalley (8 ed.). Philadelphia. pp. 98–108. 1431: 1321: 1305: 1297: 837:

MRI scan of large herniation (on the right) of the disc between L4 and L5 vertebrae

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can cause the intervertebral disc to tear or become damaged. Striving to maintain

1243:(lumbago) and often leg pain as well, in which case it is commonly referred to as 940:. EMG/NCS studies are typically used to pinpoint the sources of nerve dysfunction 4127: 3775: 3419: 3313: 3185: 3052: 2187: 2152: 1908: 897:

of the cervical, thoracic, or lumbar spinal cord. This measurement is called the

558:(TNF), is released not only by a herniated disc, but also in cases of disc tear ( 239:. If the herniated disc is in the lumbar region, the patient may also experience 4345: 4302: 4273: 4176: 4157: 3913: 3479: 2681: 1661: 1337: 1030: 867: 228: 92: 81: 3639: 3517: 3111: 3028: 2473: 2332: 2298: 2263:(3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins. p. 286. 1850: 4409: 4138: 4086: 4027: 3948: 3678: 3380: 2755: 2106: 1749: 1456: 1441: 1195: 1180: 1174: 1010: 1006: 1000: 969: 878: 730: 426: 422: 406: 299: 247:. Unlike a pulsating pain or pain that comes and goes, which can be caused by 178: 130: 17: 3933:"Surgical techniques for sciatica due to herniated disc, a systematic review" 3881: 3824: 3072: 2340: 1575: 1340:. Back exercises include the prone push-ups/press-ups, upper back extension, 711:

Illustration showing disc degeneration, prolapse, extrusion and sequestration

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herniations may be felt in the back of the skull, the neck, shoulder girdle,

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disc compresses the L5 nerve root, only if the herniation is posterolateral.

4394: 4386: 4252: 4168: 2402: 2397: 2303: 1801: 1623: 871: 410: 232: 216: 126: 114: 4045: 3966: 3899: 3842: 3744: 3686: 3626: 3607: 3525: 3427: 3388: 3321: 3278: 3242: 3193: 3158: 3121: 3080: 3036: 2851: 2808: 2773: 2716: 2646: 2481: 2435: 2358: 2210: 2195: 2160: 2125: 1942: 1927: 1868: 1819: 1757: 1669: 187:

Disc herniation is normally a further development of a previously existing

2992: 2602: 2559: 2524: 2226: 2020: 1966: 1555: 1281:

Of all individuals, 60% to 80% experience back pain during their lifetime.

4414: 4319: 4247: 4242: 1416: 1244: 1046: 994: 985: 608: 496: 480: 472: 418: 353: 240: 173:. A tear in the disc ring may result in the release of chemicals causing 3799:

Gibson, J. N. A.; Waddell, G. (2007-04-18). Gibson, JN Alastair (ed.).

1113: 975: 522: 357: 4069: 2460:

Peng B, Wu W, Li Z, Guo J, Wang X (Jan 2007). "Chemical radiculitis".

4081: 3665:

Manusov, EG (September 2012). "Surgical treatment of low back pain".

3640:

Be Wary of Spinal Decompression Therapy with VAX-D or Similar Devices

1786:"Genetic background of degenerative disc disease in the lumbar spine" 1350: 1255: 1251: 957:

spinal disc herniations from other conditions with similar symptoms.

941: 734: 468: 414: 236: 134: 3770:. Berlin, Heidelberg: Springer Berlin Heidelberg. pp. 783–791. 726: 511: 476: 458: 441:

spine (95% at L4–L5 or L5–S1). The second most common site is the

380: 310:) get pressed against the tightly stretched and thinned membrane ( 248: 211:

Typically, symptoms are experienced on one side of the body only.

4188: 1336:

Exercises that enhance back strength may also be used to prevent

668:

Normal situation and spinal disc herniation in cervical vertebrae

227:

Symptoms may include sensory changes such as numbness, tingling,

129:, pain or sensation in different parts of the body, and physical 4116: 3931:

Jacobs WC, Arts MP, van Tulder MW, et al. (November 2012).

825:

MRI scan of cervical disc herniation between C6 and C7 vertebrae

813:

MRI scan of cervical disc herniation between C5 and C6 vertebrae

376: 361: 4192: 3105: 3103: 3101: 1287:

Generally, males have a slightly higher incidence than females.

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cannot cause failed back syndrome, because no bone is removed.

797: 488: 337:, the nuclear material can pass through as a disc herniation. 138: 3217:"Predicting the outcome of sciatica at short-term follow-up" 1731: 1729: 1328:

and body alignment will aid in preventing disc degradation.

2088:

Ball, J. R.; Harris, C. B.; Lee, J.; Vives, M. J. (2019).

495:

is the most commonly affected nerve, causing symptoms of

177:, which can result in severe pain even in the absence of 861:

Example of a herniated disc at L5–S1 in the lumbar spine

321:

and aging. With degeneration, the disc components – the

165:(on the back sides) owing to relative narrowness of the 27:

Injury to the connective tissue between spinal vertebrae

2924:

FAQ: "...the entire disc does not 'slip' out of place."

1384: 3506:

Journal of Manipulative and Physiological Therapeutics

3110:

Al Qaraghli, MI; De Jesus, O (2021), "article-24453",

2738:

Sakuma Y, Ohtori S, Miyagi M, et al. (Aug 2007).

1304:

prevention methods have been applied primarily toward

615:, and black disc (a totally degenerated spinal disc). 583:

Terms commonly used to describe the condition include

145:

strength and an awareness of body mechanics including

3768:

Advanced Concepts in Lumbar Degenerative Disk Disease

1616:"Frequency of asymptomatic cervical disc protrusions" 1274:

are more likely causes of low back pain or leg pain.

437:

The majority of spinal disc herniations occur in the

4059: 3660: 3658: 2035:"Herniated disk: 6 safe exercises and what to avoid" 599:. Other conditions that are closely related include 4430: 4385: 4338: 4295: 4286: 4261: 4233: 4226: 4148: 4063: 243:due to irritation of one of the nerve roots of the 91: 75: 54: 49: 37:"Slipped disc" redirects here. For other uses, see 3215:Vroomen PC, de Krom MC, Knottnerus JA (Feb 2002). 3801:"Surgical interventions for lumbar disc prolapse" 2874:"Slipped discs: "they do not actually 'slip'..."" 680:Illustration depicting herniated disc and spinal 3017:Archives of Physical Medicine and Rehabilitation 1262:is still a gelatin-like substance. With age the 471:. Here, symptoms can be felt in the lower back, 3116:, Treasure Island (FL): StatPearls Publishing, 1708:Simeone, F.A.; Herkowitz, H.N.; Garfin (2006). 231:, and motor changes such as muscular weakness, 133:. The most conclusive diagnostic tool for disc 4204: 3467:International Journal of Osteopathic Medicine 2064:"What is the physical toll of playing rugby?" 1526:"Backache from Occiput to Coccyx | Home Page" 8: 2283:: CS1 maint: multiple names: authors list ( 1769: 1767: 849:A rather severe herniation of the L4–L5 disc 635:Spinal disc herniation is known in Latin as 3805:The Cochrane Database of Systematic Reviews 3715:The Cochrane Database of Systematic Reviews 2455: 2453: 2253: 2251: 2249: 2247: 1206:endoscopic transforaminal lumbar discectomy 4292: 4230: 4211: 4197: 4189: 4060: 3858:"Rehabilitation after lumbar disc surgery" 1833:Hirose, Yuichiro; et al. (May 2008). 1599:: CS1 maint: location missing publisher ( 67: 46: 4035: 3956: 3889: 3832: 3734: 3616: 3606: 3232: 2763: 2348: 2115: 2105: 1917: 1907: 1858: 1809: 1089:and on whether they may or may not help: 4010:Leung VY, Chan D, Cheung KM (Aug 2006). 3271:10.7326/0003-4819-157-12-201212180-00564 2940: 2938: 2670:Drug Discovery Today: Disease Mechanisms 487:), and may radiate into the foot and/or 3862:Cochrane Database of Systematic Reviews 3402:Hahne AJ, Ford JJ, McMeeken JM (2010). 3057:Cochrane Database of Systematic Reviews 1487: 1284:In 14%, pain lasts more than two weeks. 803: 769: 646: 191:, in which the outermost layers of the 2949:. MacDonald Publishing. Archived from 2276: 1592: 1053:Initial treatment usually consists of 199:The condition may be referred to as a 2373:"Symptoms of Herniated Cervical Disc" 1187:) is non-invasive and does not cause 7: 1120:Nonsteroidal anti-inflammatory drugs 1055:nonsteroidal anti-inflammatory drugs 525:, arm, and hand. The nerves of the 2416:Clinical Neurology and Neurosurgery 1506:from the original on 8 October 2017 695:Nucleus herniating through tear in 656:Lumbar disc lesions, classification 643:Click images to see larger versions 611:, disc disease, disc degeneration, 2947:"Backache: From Occiput to Coccyx" 2844:10.1097/01.brs.0000176188.40263.f9 2709:10.1097/01.brs.0000141265.55411.30 1839:American Journal of Human Genetics 1790:Spine Surgery and Related Research 1356:Swimming is a common tool used in 1098:Education on proper body mechanics 1061:Epidural corticosteroid injections 25: 883:transcranial magnetic stimulation 2985:10.1097/00007632-198003000-00005 2801:10.1097/00007632-200405150-00011 2639:10.1097/00007632-200012010-00003 2595:10.1097/00007632-199601150-00011 2552:10.1097/00007632-198710000-00009 2013:10.1097/00007632-199503150-00001 1959:10.1097/00007632-199503150-00011 1371: 854: 842: 830: 818: 806: 772: 704: 688: 673: 661: 649: 637:prolapsus disci intervertebralis 3486:from the original on 2014-03-18 3442:from the original on 2023-05-31 3128:from the original on 2022-02-21 3087:from the original on 2022-02-21 2905:from the original on 2012-01-02 2880:from the original on 2012-03-06 2233:from the original on 2022-02-21 2070:from the original on 2021-02-27 2045:from the original on 2019-12-24 1981:from the original on 2021-05-25 1690:from the original on 2015-02-12 1630:from the original on 2009-01-08 1582:from the original on 2021-03-01 1066:US Food and Drug Administration 789:the diagnoses of radiculopathy. 167:posterior longitudinal ligament 3874:10.1002/14651858.cd003007.pub3 3817:10.1002/14651858.CD001350.pub4 3727:10.1002/14651858.CD010328.pub2 3065:10.1002/14651858.cd007431.pub2 2428:10.1016/j.clineuro.2014.06.033 1403:Future treatments may include 1270:degeneration (spondylosis) or 912:determine if myelopathy exists 375:. Mutation in genes – such as 286:. Other complications include 171:anterior longitudinal ligament 117:, usually caused by excessive 32:vertebral compression fracture 1: 4481:Bones of the vertebral column 3997:Overcoming Back and Neck Pain 3982:Overcoming Back and Neck Pain 3594:Chiropractic & Osteopathy 2517:10.1016/S0140-6736(73)90818-0 1684:"Prolapsed Disc Arizona Pain" 905:). TMS can aid physicians to: 881:can be evaluated by means of 877:The presence and severity of 516:Herniated disc at C6–C7 level 39:Slipped disc (disambiguation) 4432:Intervertebral disc disorder 3999:. Harvest House. p. 31. 3984:. Harvest House. p. 37. 3776:10.1007/978-3-662-47756-4_53 3420:10.1097/BRS.0b013e3181cc3f56 3314:10.1097/BRS.0b013e318145a360 3186:10.1016/j.clinph.2007.10.014 2188:10.3928/01477447-20111122-40 2153:10.3928/01477447-20100625-18 1909:10.1371/journal.pone.0206125 1447:Failed back surgery syndrome 1021:Sacroiliac joint dysfunction 3480:10.1016/j.ijosm.2006.08.001 3259:Annals of Internal Medicine 2682:10.1016/j.ddmec.2004.11.018 1662:10.1016/j.ejrad.2004.11.003 1557:Clinically oriented anatomy 1530:www.macdonaldpublishing.com 1181:Small endoscopic discectomy 556:tumor necrosis factor alpha 445:region (C5–C6, C6–C7). The 393:, especially those playing 4497: 3919:Herniated nucleus pulposus 3518:10.1016/j.jmpt.2003.12.023 3369:Phys Med Rehabil Clin N Am 3029:10.1016/j.apmr.2007.04.016 2474:10.1016/j.pain.2006.06.034 2333:10.5144/0256-4947.2017.130 2261:Essential clinical anatomy 1851:10.1016/j.ajhg.2008.03.013 1710:Rothman-Simeone, The Spine 1614:Windsor, Robert E (2006). 1427:Nerve compression syndrome 1185:nano-endoscopic discectomy 793:Magnetic resonance imaging 537:Intradural disc herniation 36: 29: 4445:Degenerative disc disease 4028:10.1007/s00586-006-0183-z 3949:10.1007/s00586-012-2422-9 3679:10.1016/j.pop.2012.06.010 3381:10.1016/j.pmr.2010.11.002 2756:10.1007/s00586-007-0365-3 2107:10.1186/s40798-019-0199-7 1750:10.1016/j.rcl.2012.04.014 1467:Degenerative disc disease 1156:A review of non-surgical 953:Tests may be required to 613:degenerative disc disease 319:degenerative disc disease 98:Connective tissue disease 66: 3914:MedlinePlus Encyclopedia 3587:Daniel, Dwain M (2007). 2321:Annals of Saudi Medicine 1554:Moore, Keith L. (2018). 934:nerve conduction studies 764:Projectional radiography 508:Cervical disc herniation 62:, lumbar disc herniation 30:Not to be confused with 2876:. Emedicinehealth.com. 1802:10.22603/ssrr.2017-0007 899:central conduction time 786:Computed tomographyscan 4450:Spinal disc herniation 4308:Ankylosing spondylitis 3995:Marrone, Lisa (2008). 3980:Marrone, Lisa (2008). 3608:10.1186/1746-1340-15-7 3352:. 2014. Archived from 3113:Lumbar Disc Herniation 2094:Sports Medicine - Open 1784:Kawaguchi, Y. (2018). 1738:Radiol. Clin. North Am 1620:Cervical Disc Injuries 1110:electrical stimulation 1072:Lumbar disc herniation 949:Differential diagnosis 517: 464: 107:spinal disc herniation 50:Spinal disc herniation 4476:Spinal cord disorders 4455:Facet joint arthrosis 4269:Scheuermann's disease 1472:Cauda equina syndrome 1300:, so the majority of 1016:Myocardial infarction 515: 463:Herniated lumbar disc 462: 391:Professional athletes 284:cauda equina syndrome 4022:(Suppl 3): S406–13. 2215:La Radiologia Medica 1342:transverse abdominis 1202:Failed back syndrome 1189:failed back syndrome 1158:spinal decompression 889:, starting from the 733:and space-occupying 723:physical examination 717:Physical examination 253:position of the body 109:is an injury to the 3460:Snelling N (2006). 2398:Cervical herniation 2041:. 28 January 2019. 1900:2018PLoSO..1306125S 1686:. arizonapain.com. 1147:Spinal manipulation 1131:Spinal manipulation 895:anterior horn cells 481:anal/genital region 235:, and affection of 125:. It may result in 113:between two spinal 111:intervertebral disc 4149:External resources 3645:2019-06-20 at the 3571:2020-04-29 at the 2929:2010-01-06 at the 2066:. September 2015. 2039:Medical News Today 1452:Intervetebral disc 1383:. You can help by 1087:risk–benefit ratio 1005:Benign tumor like 893:and ending at the 747:straight leg raise 741:Straight leg raise 518: 465: 350:vitamin D receptor 207:Signs and symptoms 4463: 4462: 4381: 4380: 4356:Spondylolisthesis 4282: 4281: 4186: 4185: 3785:978-3-662-47755-7 3356:on April 6, 2017. 3174:Clin Neurophysiol 2945:Burke, Gerald L. 2901:. Spine-inc.com. 2299:Lumbar herniation 2270:978-0-7817-6274-8 1567:978-1-4963-4721-3 1437:Neuroinflammation 1405:stem cell therapy 1401: 1400: 1358:strength training 1035:spondylolisthesis 981:Aortic dissection 938:nerve compression 682:nerve compression 630:spondylolisthesis 618:The popular term 607:(pinched nerve), 552:nerve compression 533:can be affected. 399:American football 121:or trauma to the 103: 102: 44:Medical condition 16:(Redirected from 4488: 4339:non inflammatory 4325:Spondylodiscitis 4293: 4235:Spinal curvature 4231: 4213: 4206: 4199: 4190: 4061: 4050: 4049: 4039: 4007: 4001: 4000: 3992: 3986: 3985: 3977: 3971: 3970: 3960: 3928: 3922: 3910: 3904: 3903: 3893: 3853: 3847: 3846: 3836: 3796: 3790: 3789: 3763: 3757: 3756: 3738: 3706: 3700: 3697: 3691: 3690: 3662: 3653: 3637: 3631: 3630: 3620: 3610: 3584: 3578: 3563: 3557: 3554: 3548: 3545: 3539: 3536: 3530: 3529: 3501: 3495: 3494: 3492: 3491: 3457: 3451: 3450: 3448: 3447: 3414:(11): E488–504. 3399: 3393: 3392: 3364: 3358: 3357: 3340: 3334: 3333: 3297: 3291: 3290: 3253: 3247: 3246: 3236: 3212: 3206: 3205: 3169: 3163: 3162: 3142: 3136: 3135: 3134: 3133: 3107: 3096: 3095: 3093: 3092: 3047: 3041: 3040: 3011: 3005: 3004: 2968: 2962: 2961: 2959: 2958: 2942: 2933: 2920: 2914: 2913: 2911: 2910: 2899:"Prolapsed disc" 2895: 2889: 2888: 2886: 2885: 2870: 2864: 2863: 2827: 2821: 2820: 2784: 2778: 2777: 2767: 2735: 2729: 2728: 2692: 2686: 2685: 2665: 2659: 2658: 2621: 2615: 2614: 2578: 2572: 2571: 2535: 2529: 2528: 2500: 2494: 2493: 2457: 2448: 2447: 2411: 2405: 2394: 2388: 2387: 2385: 2384: 2375:. Archived from 2369: 2363: 2362: 2352: 2312: 2306: 2295: 2289: 2288: 2282: 2274: 2255: 2242: 2241: 2239: 2238: 2206: 2200: 2199: 2171: 2165: 2164: 2136: 2130: 2129: 2119: 2109: 2085: 2079: 2078: 2076: 2075: 2060: 2054: 2053: 2051: 2050: 2031: 2025: 2024: 1996: 1990: 1989: 1987: 1986: 1938: 1932: 1931: 1921: 1911: 1894:(10): e0206125. 1879: 1873: 1872: 1862: 1845:(5): 1122–1129. 1830: 1824: 1823: 1813: 1781: 1775: 1771: 1762: 1761: 1733: 1724: 1723: 1705: 1699: 1698: 1696: 1695: 1680: 1674: 1673: 1645: 1639: 1638: 1636: 1635: 1611: 1605: 1604: 1598: 1590: 1588: 1587: 1551: 1545: 1544: 1542: 1541: 1532:. Archived from 1522: 1516: 1515: 1513: 1511: 1496:"Herniated disk" 1492: 1396: 1393: 1375: 1368: 1310:physical fitness 1264:nucleus pulposus 1260:nucleus pulposus 1211:The presence of 1102:Physical therapy 930:Electromyography 887:pyramidal tracts 858: 846: 834: 822: 810: 776: 708: 692: 677: 665: 653: 451:annulus fibrosus 346:type IX collagen 327:annulus fibrosus 323:nucleus pulposus 312:annulus fibrosus 308:nucleus pulposus 260:nucleus pulposus 193:annulus fibrosus 169:relative to the 158:annulus fibrosus 71: 60:nucleus pulposus 47: 21: 4496: 4495: 4491: 4490: 4489: 4487: 4486: 4485: 4466: 4465: 4464: 4459: 4440:Schmorl's nodes 4426: 4400:Upper back pain 4377: 4368:Spinal stenosis 4334: 4278: 4257: 4222: 4217: 4187: 4182: 4181: 4144: 4143: 4072: 4058: 4053: 4009: 4008: 4004: 3994: 3993: 3989: 3979: 3978: 3974: 3943:(11): 2232–51. 3930: 3929: 3925: 3911: 3907: 3868:(3): CD003007. 3855: 3854: 3850: 3811:(2): CD001350. 3798: 3797: 3793: 3786: 3765: 3764: 3760: 3721:(9): CD010328. 3708: 3707: 3703: 3698: 3694: 3664: 3663: 3656: 3651:Stephen Barrett 3647:Wayback Machine 3638: 3634: 3586: 3585: 3581: 3573:Wayback Machine 3564: 3560: 3555: 3551: 3546: 3542: 3537: 3533: 3503: 3502: 3498: 3489: 3487: 3459: 3458: 3454: 3445: 3443: 3401: 3400: 3396: 3366: 3365: 3361: 3342: 3341: 3337: 3308:(19): 2144–51. 3299: 3298: 3294: 3255: 3254: 3250: 3227:(475): 119–23. 3214: 3213: 3209: 3171: 3170: 3166: 3144: 3143: 3139: 3131: 3129: 3109: 3108: 3099: 3090: 3088: 3059:(2): CD007431. 3049: 3048: 3044: 3013: 3012: 3008: 2970: 2969: 2965: 2956: 2954: 2944: 2943: 2936: 2931:Wayback Machine 2921: 2917: 2908: 2906: 2897: 2896: 2892: 2883: 2881: 2872: 2871: 2867: 2829: 2828: 2824: 2795:(10): 1105–11. 2786: 2785: 2781: 2737: 2736: 2732: 2694: 2693: 2689: 2667: 2666: 2662: 2633:(23): 2975–80. 2623: 2622: 2618: 2580: 2579: 2575: 2537: 2536: 2532: 2502: 2501: 2497: 2459: 2458: 2451: 2413: 2412: 2408: 2395: 2391: 2382: 2380: 2371: 2370: 2366: 2314: 2313: 2309: 2296: 2292: 2275: 2271: 2257: 2256: 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stenosis 548: 539: 531:brachial plexus 527:cervical plexus 510: 435: 433:Pathophysiology 342:type I collagen 296: 209: 189:disc protrusion 45: 42: 35: 28: 23: 22: 15: 12: 11: 5: 4494: 4492: 4484: 4483: 4478: 4468: 4467: 4461: 4460: 4458: 4457: 4452: 4447: 4442: 4436: 4434: 4428: 4427: 4425: 4424: 4419: 4418: 4417: 4412: 4402: 4397: 4391: 4389: 4383: 4382: 4379: 4378: 4376: 4375: 4373:Facet syndrome 4370: 4365: 4364: 4363: 4361:Retrolisthesis 4353: 4348: 4342: 4340: 4336: 4335: 4333: 4332: 4330:Pott's disease 4327: 4322: 4317: 4312: 4311: 4310: 4299: 4297: 4290: 4284: 4283: 4280: 4279: 4277: 4276: 4271: 4265: 4263: 4259: 4258: 4256: 4255: 4250: 4245: 4239: 4237: 4228: 4224: 4223: 4220:Spinal disease 4218: 4216: 4215: 4208: 4201: 4193: 4184: 4183: 4180: 4179: 4165: 4153: 4152: 4150: 4146: 4145: 4142: 4141: 4130: 4119: 4108: 4089: 4073: 4068: 4067: 4065: 4064:Classification 4057: 4056:External links 4054: 4052: 4051: 4002: 3987: 3972: 3923: 3905: 3848: 3791: 3784: 3758: 3701: 3692: 3654: 3632: 3579: 3558: 3549: 3540: 3531: 3512:(3): 197–210. 3496: 3452: 3394: 3359: 3335: 3292: 3265:(12): 865–77. 3248: 3221:Br J Gen Pract 3207: 3164: 3137: 3097: 3042: 3006: 2963: 2934: 2922:Ehealthmd.com 2915: 2890: 2865: 2838:(17): 1940–8. 2822: 2779: 2730: 2703:(19): 2091–5. 2687: 2660: 2616: 2573: 2530: 2495: 2449: 2406: 2389: 2364: 2327:(2): 130–137. 2307: 2290: 2269: 2243: 2201: 2166: 2147:(8): 566–568. 2131: 2080: 2055: 2026: 1991: 1953:(6): 699–709. 1933: 1874: 1825: 1776: 1774:2015;49:589-94 1763: 1725: 1718: 1700: 1675: 1640: 1606: 1566: 1546: 1517: 1486: 1484: 1481: 1480: 1479: 1474: 1469: 1464: 1459: 1454: 1449: 1444: 1439: 1434: 1429: 1424: 1419: 1412: 1409: 1399: 1398: 1378: 1376: 1365: 1362: 1333: 1330: 1326:proper posture 1317: 1314: 1293: 1290: 1289: 1288: 1285: 1282: 1279: 1268:osteoarthritic 1236: 1233: 1220: 1219: 1209: 1199: 1192: 1178: 1167: 1164: 1163: 1162: 1161:controversial. 1154: 1144: 1139: 1136: 1135: 1134: 1128: 1126:Weight control 1123: 1117: 1099: 1094: 1091: 1073: 1070: 1042: 1039: 1038: 1037: 1028: 1023: 1018: 1013: 1003: 997: 992: 983: 978: 973: 967: 964: 950: 947: 946: 945: 926: 925: 924: 923: 920: 917: 913: 907: 906: 875: 864: 863: 860: 853: 851: 848: 841: 839: 836: 829: 827: 824: 817: 815: 812: 805: 802: 801: 790: 782: 781: 778: 771: 768: 767: 759: 758:Spinal imaging 756: 742: 739: 718: 715: 714: 713: 710: 703: 701: 694: 687: 685: 679: 672: 670: 667: 660: 658: 655: 648: 645: 644: 589:prolapsed disc 585:herniated disc 580: 577: 575: 572: 547: 544: 538: 535: 509: 506: 485:perineal nerve 434: 431: 395:contact sports 295: 292: 208: 205: 163:posterolateral 101: 100: 95: 89: 88: 79: 73: 72: 64: 63: 56: 52: 51: 43: 26: 24: 18:Herniated disk 14: 13: 10: 9: 6: 4: 3: 2: 4493: 4482: 4479: 4477: 4474: 4473: 4471: 4456: 4453: 4451: 4448: 4446: 4443: 4441: 4438: 4437: 4435: 4433: 4429: 4423: 4422:Radiculopathy 4420: 4416: 4413: 4411: 4408: 4407: 4406: 4405:Low back pain 4403: 4401: 4398: 4396: 4393: 4392: 4390: 4388: 4384: 4374: 4371: 4369: 4366: 4362: 4359: 4358: 4357: 4354: 4352: 4351:Spondylolysis 4349: 4347: 4344: 4343: 4341: 4337: 4331: 4328: 4326: 4323: 4321: 4318: 4316: 4313: 4309: 4306: 4305: 4304: 4301: 4300: 4298: 4294: 4291: 4289: 4288:Spondylopathy 4285: 4275: 4272: 4270: 4267: 4266: 4264: 4260: 4254: 4251: 4249: 4246: 4244: 4241: 4240: 4238: 4236: 4232: 4229: 4225: 4221: 4214: 4209: 4207: 4202: 4200: 4195: 4194: 4191: 4178: 4175: 4171: 4170: 4166: 4164: 4160: 4159: 4155: 4154: 4151: 4147: 4140: 4136: 4135: 4131: 4129: 4125: 4124: 4120: 4118: 4114: 4113: 4109: 4107: 4103: 4099: 4098: 4094: 4090: 4088: 4084: 4083: 4079: 4075: 4074: 4071: 4066: 4062: 4055: 4047: 4043: 4038: 4033: 4029: 4025: 4021: 4017: 4013: 4006: 4003: 3998: 3991: 3988: 3983: 3976: 3973: 3968: 3964: 3959: 3954: 3950: 3946: 3942: 3938: 3934: 3927: 3924: 3920: 3916: 3915: 3909: 3906: 3901: 3897: 3892: 3887: 3883: 3879: 3875: 3871: 3867: 3863: 3859: 3852: 3849: 3844: 3840: 3835: 3830: 3826: 3822: 3818: 3814: 3810: 3806: 3802: 3795: 3792: 3787: 3781: 3777: 3773: 3769: 3762: 3759: 3754: 3750: 3746: 3742: 3737: 3732: 3728: 3724: 3720: 3716: 3712: 3705: 3702: 3696: 3693: 3688: 3684: 3680: 3676: 3673:(3): 525–31. 3672: 3668: 3661: 3659: 3655: 3652: 3648: 3644: 3641: 3636: 3633: 3628: 3624: 3619: 3614: 3609: 3604: 3600: 3596: 3595: 3590: 3583: 3580: 3577: 3574: 3570: 3567: 3562: 3559: 3553: 3550: 3544: 3541: 3535: 3532: 3527: 3523: 3519: 3515: 3511: 3507: 3500: 3497: 3485: 3481: 3477: 3473: 3469: 3468: 3463: 3456: 3453: 3441: 3437: 3433: 3429: 3425: 3421: 3417: 3413: 3409: 3405: 3398: 3395: 3390: 3386: 3382: 3378: 3375:(1): 105–25. 3374: 3370: 3363: 3360: 3355: 3351: 3350: 3345: 3339: 3336: 3331: 3327: 3323: 3319: 3315: 3311: 3307: 3303: 3296: 3293: 3288: 3284: 3280: 3276: 3272: 3268: 3264: 3260: 3252: 3249: 3244: 3240: 3235: 3230: 3226: 3222: 3218: 3211: 3208: 3203: 3199: 3195: 3191: 3187: 3183: 3180:(3): 504–32. 3179: 3175: 3168: 3165: 3160: 3156: 3153:(2): 99–105. 3152: 3148: 3141: 3138: 3127: 3123: 3119: 3115: 3114: 3106: 3104: 3102: 3098: 3086: 3082: 3078: 3074: 3070: 3066: 3062: 3058: 3054: 3046: 3043: 3038: 3034: 3030: 3026: 3022: 3018: 3010: 3007: 3002: 2998: 2994: 2990: 2986: 2982: 2979:(2): 117–25. 2978: 2974: 2967: 2964: 2953:on 2014-08-08 2952: 2948: 2941: 2939: 2935: 2932: 2928: 2925: 2919: 2916: 2904: 2900: 2894: 2891: 2879: 2875: 2869: 2866: 2861: 2857: 2853: 2849: 2845: 2841: 2837: 2833: 2826: 2823: 2818: 2814: 2810: 2806: 2802: 2798: 2794: 2790: 2783: 2780: 2775: 2771: 2766: 2761: 2757: 2753: 2750:(8): 1273–8. 2749: 2745: 2741: 2734: 2731: 2726: 2722: 2718: 2714: 2710: 2706: 2702: 2698: 2691: 2688: 2683: 2679: 2675: 2671: 2664: 2661: 2656: 2652: 2648: 2644: 2640: 2636: 2632: 2628: 2620: 2617: 2612: 2608: 2604: 2600: 2596: 2592: 2589:(2): 218–24. 2588: 2584: 2577: 2574: 2569: 2565: 2561: 2557: 2553: 2549: 2545: 2541: 2534: 2531: 2526: 2522: 2518: 2514: 2511:(7824): 320. 2510: 2506: 2499: 2496: 2491: 2487: 2483: 2479: 2475: 2471: 2468:(1–2): 11–6. 2467: 2463: 2456: 2454: 2450: 2445: 2441: 2437: 2433: 2429: 2425: 2421: 2417: 2410: 2407: 2404: 2400: 2399: 2393: 2390: 2379:on 2016-05-16 2378: 2374: 2368: 2365: 2360: 2356: 2351: 2346: 2342: 2338: 2334: 2330: 2326: 2322: 2318: 2311: 2308: 2305: 2301: 2300: 2294: 2291: 2286: 2280: 2272: 2266: 2262: 2254: 2252: 2250: 2248: 2244: 2232: 2228: 2224: 2221:(6): 757–60. 2220: 2216: 2212: 2205: 2202: 2197: 2193: 2189: 2185: 2181: 2177: 2170: 2167: 2162: 2158: 2154: 2150: 2146: 2142: 2135: 2132: 2127: 2123: 2118: 2113: 2108: 2103: 2099: 2095: 2091: 2084: 2081: 2069: 2065: 2059: 2056: 2044: 2040: 2036: 2030: 2027: 2022: 2018: 2014: 2010: 2006: 2002: 1995: 1992: 1980: 1976: 1972: 1968: 1964: 1960: 1956: 1952: 1948: 1944: 1937: 1934: 1929: 1925: 1920: 1915: 1910: 1905: 1901: 1897: 1893: 1889: 1885: 1878: 1875: 1870: 1866: 1861: 1856: 1852: 1848: 1844: 1840: 1836: 1829: 1826: 1821: 1817: 1812: 1807: 1803: 1799: 1796:(2): 98–112. 1795: 1791: 1787: 1780: 1777: 1770: 1768: 1764: 1759: 1755: 1751: 1747: 1744:(4): 629–49. 1743: 1739: 1732: 1730: 1726: 1721: 1719:9780721647777 1715: 1711: 1704: 1701: 1689: 1685: 1679: 1676: 1671: 1667: 1663: 1659: 1656:(3): 409–14. 1655: 1651: 1644: 1641: 1629: 1625: 1621: 1617: 1610: 1607: 1602: 1596: 1581: 1577: 1573: 1569: 1563: 1559: 1558: 1550: 1547: 1536:on 2019-03-16 1535: 1531: 1527: 1521: 1518: 1505: 1501: 1497: 1491: 1488: 1482: 1478: 1475: 1473: 1470: 1468: 1465: 1463: 1462:Low back pain 1460: 1458: 1455: 1453: 1450: 1448: 1445: 1443: 1440: 1438: 1435: 1433: 1430: 1428: 1425: 1423: 1422:Radiculopathy 1420: 1418: 1415: 1414: 1410: 1408: 1406: 1395: 1386: 1382: 1379:This section 1377: 1374: 1370: 1369: 1363: 1361: 1359: 1354: 1352: 1348: 1343: 1339: 1338:back injuries 1331: 1329: 1327: 1323: 1315: 1313: 1311: 1307: 1303: 1302:low back pain 1299: 1291: 1286: 1283: 1280: 1277: 1276: 1275: 1273: 1269: 1265: 1261: 1257: 1253: 1248: 1246: 1242: 1241:low back pain 1234: 1232: 1228: 1226: 1217: 1215: 1210: 1207: 1203: 1200: 1197: 1193: 1190: 1186: 1182: 1179: 1176: 1173: 1172: 1171: 1165: 1159: 1155: 1152: 1148: 1145: 1142: 1141: 1137: 1132: 1129: 1127: 1124: 1121: 1118: 1115: 1111: 1107: 1103: 1100: 1097: 1096: 1092: 1090: 1088: 1084: 1080: 1071: 1069: 1067: 1062: 1058: 1056: 1051: 1048: 1040: 1036: 1032: 1029: 1027: 1024: 1022: 1019: 1017: 1014: 1012: 1008: 1004: 1002: 998: 996: 993: 991: 990:osteomyelitis 987: 984: 982: 979: 977: 974: 971: 968: 965: 963: 960: 959: 958: 956: 948: 944:to the spine. 943: 939: 935: 931: 928: 927: 921: 918: 914: 911: 910: 909: 908: 904: 900: 896: 892: 888: 884: 880: 876: 873: 869: 866: 865: 857: 852: 845: 840: 833: 828: 821: 816: 809: 804: 799: 794: 791: 787: 784: 783: 775: 770: 765: 762: 761: 757: 755: 752: 748: 740: 738: 736: 732: 728: 724: 716: 707: 702: 698: 691: 686: 683: 676: 671: 664: 659: 652: 647: 642: 641: 640: 638: 633: 631: 626: 621: 616: 614: 610: 606: 605:radiculopathy 602: 598: 594: 593:ruptured disc 590: 586: 578: 573: 571: 569: 565: 561: 557: 553: 545: 543: 536: 534: 532: 528: 524: 514: 507: 505: 502: 501:femoral nerve 498: 494: 493:sciatic nerve 490: 486: 482: 478: 474: 470: 461: 457: 455: 452: 448: 444: 440: 432: 430: 428: 424: 420: 416: 412: 408: 404: 400: 396: 392: 388: 384: 382: 378: 374: 373:polymorphisms 371: 370:interleukin-6 367: 366:interleukin-1 363: 359: 355: 351: 347: 343: 338: 336: 332: 328: 324: 320: 315: 313: 309: 305: 301: 293: 291: 289: 285: 281: 277: 276: 270: 267: 265: 261: 256: 254: 250: 246: 245:sciatic nerve 242: 238: 234: 230: 225: 222: 221:low back pain 218: 212: 206: 204: 202: 197: 194: 190: 185: 183: 180: 176: 172: 168: 164: 160: 159: 153: 150: 148: 144: 140: 136: 132: 128: 124: 120: 116: 112: 108: 99: 96: 94: 90: 87: 83: 80: 78: 74: 70: 65: 61: 57: 53: 48: 40: 33: 19: 4449: 4315:Sacroiliitis 4296:inflammatory 4174:orthoped/138 4167: 4156: 4132: 4121: 4110: 4091: 4076: 4019: 4015: 4005: 3996: 3990: 3981: 3975: 3940: 3936: 3926: 3912: 3908: 3865: 3861: 3851: 3808: 3804: 3794: 3767: 3761: 3718: 3714: 3704: 3695: 3670: 3667:Primary Care 3666: 3635: 3598: 3592: 3582: 3561: 3552: 3543: 3534: 3509: 3505: 3499: 3488:. Retrieved 3474:(3): 77–84. 3471: 3465: 3455: 3444:. Retrieved 3411: 3407: 3397: 3372: 3368: 3362: 3354:the original 3347: 3338: 3305: 3301: 3295: 3262: 3258: 3251: 3224: 3220: 3210: 3177: 3173: 3167: 3150: 3147:Funct Neurol 3146: 3140: 3130:, retrieved 3112: 3089:. Retrieved 3056: 3045: 3023:(7): 840–3. 3020: 3016: 3009: 2976: 2972: 2966: 2955:. Retrieved 2951:the original 2918: 2907:. Retrieved 2893: 2882:. Retrieved 2868: 2835: 2831: 2825: 2792: 2788: 2782: 2747: 2743: 2733: 2700: 2696: 2690: 2676:(4): 441–8. 2673: 2669: 2663: 2630: 2626: 2619: 2586: 2582: 2576: 2546:(8): 760–4. 2543: 2539: 2533: 2508: 2504: 2498: 2465: 2461: 2419: 2415: 2409: 2396: 2392: 2381:. Retrieved 2377:the original 2367: 2324: 2320: 2310: 2297: 2293: 2260: 2235:. Retrieved 2218: 2214: 2204: 2182:(1): 43–49. 2179: 2175: 2169: 2144: 2140: 2134: 2097: 2093: 2083: 2072:. Retrieved 2058: 2047:. Retrieved 2038: 2029: 2007:(6): 635–9. 2004: 2000: 1994: 1983:. Retrieved 1950: 1946: 1936: 1891: 1887: 1877: 1842: 1838: 1828: 1793: 1789: 1779: 1741: 1737: 1709: 1703: 1692:. Retrieved 1678: 1653: 1650:Eur J Radiol 1649: 1643: 1632:. Retrieved 1619: 1609: 1584:. Retrieved 1556: 1549: 1538:. Retrieved 1534:the original 1529: 1520: 1508:. 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