Each of the 26 vertebrae in your spinal column is cushioned by a disc. The discs work as shock absorbers so the bones don’t push against each other during daily activities, such as walking, twisting, and lifting. Each disc is like a cushion with a tough outer coating that is filled with a soft, gel-like substance. If an injury occurs, the soft inner substance can be squeezed out of the outer covering. This is called a herniated or slipped disc. It can be very painful if it pushes against a spinal nerve.
Diagnosis
Herniated discs are diagnosed through several means. The first thing a doctor will do is give you a physical exam. He or she will look for the origin of the pain. Your muscle strength and nerve functions will be checked, and the doctor will ask whether you feel pain when he or she moves or touches the affected area. The doctor will ask about your medical history, when you first felt the pain and if you can attribute the pain to a particular activity. A neurological exam may help your doctor determine the cause of your pain.
Tests
Your physician will also use imaging tests to view your spinal bones and muscles to try to identify the damaged areas. The combined information obtained from the scans and physical will help the doctor determine the source of your pain or discomfort. Some of the imaging scans may include:
- Computerized tomography (CT scans) – takes many pictures that are combined to show a cross-sectional image of your spinal column
- X-rays – do not detect herniated disc but are used to rule out other issues such as tumor, broken bone, or spinal alignment
- Magnetic resonance imaging (MRI scans) – used to create an image of your internal structures. It will show the location of the slipped disc and which nerves are affected
- Myelogram – involves a dye injected into your spinal fluid that will show where the pressure is on your spinal cord or nerves in an X-ray
Specialists
There are several types of specialists who treat back and neck pain. Your first stop is your general practitioner (GP). He or she can start the diagnosis process and, through certain tests, determine what type of specialist is best for you. If the slipped disc is caused by an accident, you should go to an emergency room immediately.
Many insurance companies require you to see a GP first before you contact one of the following specialists:
- An orthopedist treats bones and muscles and is the specialist most people see when they have a herniated disc.
- A neurologist may be required to determine if your nerves are impairing your reflexes, balance, or strength. Neurologists are usually consulted for chronic back and neck pain.
- A rheumatologist will be recommended if you are suffering from an autoimmune or connective tissue disease.
- A neurosurgeon will be required if you need spinal column, spinal cord, or open back surgery. This is usually a last resort.
